PAR-Q+

ConqHer Fitness – PAR-Q+ Form

Physical Activity Readiness Questionnaire

Empowering Women to Move Safely & Confidently

Step 1: Personal Information

First Name

Last Name

Phone

Membership ID / Order Number

Step 2: General Health Screening

Please answer Yes or No to each question honestly.

1. Has a doctor ever said you have a heart condition or high blood pressure?

Yes No

2. Do you experience chest pain at rest, during daily activities, or physical activity?

Yes No

3. Have you ever lost balance due to dizziness or lost consciousness in the past year?

Yes No

4. Have you been diagnosed with any chronic condition (excluding heart disease or high blood pressure)?

Yes No

5. Are you currently prescribed medications for a chronic condition?

Yes No

6. Do you have (or have had in the past 12 months) any bone, joint, or soft tissue issues that could worsen with physical activity?

Yes No

7. Has your doctor ever advised you to only perform medically supervised physical activity?

Yes No

✅ If you answered NO to all questions, you are cleared to begin physical activity at ConqHer Fitness.
⚠️ If you answered YES to one or more, please complete Step 2 below.

Step 3: Medical Condition Details

Please check any that apply and provide additional information.

• Arthritis, Osteoporosis, or Back Problems

Difficulty managing condition with medication or therapy Joint stiffness, swelling, or limited movement History of fractures or bone fragility Recent back pain (within the past 12 months)

• Asthma or Lung Conditions

Breathing issues during exercise Frequent coughing or wheezing with activity

• Diabetes, Thyroid, Anemia, or Other Metabolic Conditions

Blood sugar or condition is difficult to manage Fatigue, dizziness, or shortness of breath with activity

• Cancer

Currently undergoing treatment or experiencing symptoms

Step 4: Your Intentions at ConqHer

• Do you plan to begin a workout program including strength training, cardio, or group fitness?

Yes No

If yes, what are your personal fitness goals?

Declaration & Consent

I confirm that the information provided above is true and accurate to the best of my knowledge. I understand it is my responsibility to consult with my physician if I experience any changes in my health.

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