PARQ Name Name First First Last Last Have you ever suffered from heart trouble? * No Yes Are you currently taking any form of medication? * No Yes Do you suffer from chest pains? * No Yes Do you ever have spells of dizziness or feel faint? * No Yes Have you ever had high/low blood pressure and/or high cholesterol? * No Yes Have you ever had asthma, bronchitis, or any other chest ailments? * No Yes Do you suffer from back pains, or any other orthopaedic problem? * No Yes Do you suffer from severe headaches or migraines? * No Yes Are you recovering from a recent illness, operation, or injury? * No Yes Have you any medical condition that we should be aware of? * No Yes Are you pregnant? * No Yes By how many months are you pregnant? Is there any history of heart disease in your immediate family (under the age of 55)? * No Yes If you have any further information you would like us to be aware of, please enter it here If you have answered YES to the above... It is important that if you have answered yes to any of the above questions, you are advised to seek medical approval before commencing your course. By choosing to proceed without this advice, you accept all risks associated with your participation. I confirm that I have provided honest responses and understand that neither the tutor, nor The Vocational Academy can be held liable for any injuries or health issues that may arise following the advice given. Signature signature keyboard Clear Submit If you are human, leave this field blank.
