身體狀況安全問卷調查
PAR-Q FORM
(為年齡介乎１５至６９人士之問卷)
(A Questionnaire for People Aged 15 to 69)
會員姓名Name : __ 會員號碼Membership No.: __
為閣下安全，請回答以下問題（在適用處(打上(號）
For your safety, please answer the following questions by ticking (() the appropriate box (()
沒有 有（或不清楚）
NO YES or not sure( (你的醫生有否告訴你，你的心臟有問題，並要求你只能在醫生建議的情況下才能進行運動？
Does your doctor ever said that you have a heart condition and so that you should only do physical activity recommended by a doctor( (當你進行運動時，胸腔有否感到痛楚？
Do you feel pain in your chest when you do physical activity( (在過往一個月，你曾否試過在沒有運動情況下出現胸腔痛楚感覺？
In the past month, did you have chest pain when you were not doing physical activity( (你有否由於頭暈而導致失去平沖，或至失去知感？
Do you lose your balance because of dizziness or do you ever lose consciousness( (你有否因改變你的運動計畫而導致骨骼或關節問題惡化的情況？
Do you have a bone or joint problem that could be made worse by a change in your physical activity( (你的醫生現時有否開藥方給你用於血壓或心臟等問題？
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart