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Complete Your PAR-Q Form

Before your consultation, complete this questionnaire so we can understand your health history and anything that may affect your training.

Your information will be treated as confidential and used only to evaluate your readiness for training and support your Pure Conditioning program.

Member Par-Q (Stamford)

Exercise

Which exercise goals and/or results are most important to you? Check all that apply:
How would you rate your exercise level
How would you classify your current activity level?
How much time per week do you exercise currently?

Diet

How much water do you think you should drink per day?
How much water do you drink per day?
How often do you eat home cooked meals?
How often do you eat in restaurants?

Medical History

Select yes or no to the conditions listed below. If you answer yes to any, it may be necessary to obtain medical clearance before engaging in our exercise program.

Symptoms

Do you have any of the following symptoms? Check all that apply.

If you have ANY of the above symptoms, you may have chemical or heavy metal toxicity. Many of these symptoms can turn into more serious conditions
if toxicity is left untreated

Sleep

Do you sleep restfully?

Bowel Health

How often do you have a bowel movement?
How often do you have diarrhea and/or constipation?
How often do you experience gas and/or bloating?

Holistic Care

How often do you get a massage?