Health appraisal form
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This health appraisal form from JH Cerilles State College collects a student's name, date of testing, height, weight, age, BMI, course, and has them complete a PAR-Q physical activity readiness questionnaire. The PAR-Q asks 7 yes or no questions about any heart conditions, chest pains, joint problems, or medications that could be affected by a change in physical activity. Any students answering yes to any questions are advised to consult their physician before engaging in physical activity.
Health appraisal form
- 1. JH Cerilles State College Mati, San Miguel, Zamboanga del Sur --oooo-- Health Appraisal Form Name: _____________________________________Date of Testing: _________ Height: _____in. Weight: _____lbs. Age: __________ BMI: __________ Course: _______ PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q) Directions: Put a check (/) mark to every question applied for you. Questions Yes No 1 Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? 2 Do you feel pain in your chest when you perform physical activity? 3 In the past month, have you had chest pain when you were not performing any physical activity? 4 Do you lose your balance because of dizziness or do you ever lose consciousness? 5 Do you have a bone or joint problem that could be made worse by a change in your physical activity? 6 Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? 7 Do you know of any other reason why you should not engage in physical activity? Note: If you have answered Yes to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered Yes. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. Physicians Name and signature: _______________________ Parents Signature: __________________________________ Parents Contact Number: _____________________________