PARQ FORM

PERFORMANCE BREATH TRAINING QUESTIONNAIRE

X JEREMY WARNER

Performance Breath Training

Physical Readiness Questionnaire (PARQ)

Welcome to Performance Breath Training!

Thank you for taking a moment to complete the Physical Readiness Questionnaire. Your responses help us understand your health background so we can tailor your training safely and effectively. Please answer honestly and thoroughly—we’re here to support your progress every step of the way.

Your Information

First name

Last name

Phone

Health Assessment / Medical History

Have you ever experienced manual muscle testing, or any therapy/treatment that assessed your muscular system? i.e Physical Therapy, Massage, Rolfing, A.R.T) If so, what was your experience with it?

Have you ever experienced any form of a breath practice? (Hyperventilation, Hypoventilation, Pranayama, Box Breathing). If so, how was your experience and what was the outcome from the breath practice?

Have you had any experience with Deliberate Hot or Cold Exposure? Sauna (Dry, Wet, Infrared), Hot Tub, Ice Baths, Facial Ice Baths, Cryotherapy. If so, please expound on your experience and their outcomes.

Can you recall any specific injuries in your life where a bone was broken or dislocated/subluxed, a ligament, tendon or muscle was strained or torn, a joint sprained, or abnormally swollen? If yes, please describe.

How active are you each week? Measured in intentional exercise, times performed, duration of time and level of intensity? i.e. High, High to Moderate, Moderate, Moderate to Light, Light.

How do you feel after a workout or intentional activities? What is your level of soreness and symmetry of that soreness?( i.e. Does it feel the same on both sides of your body) How long does it last and how energized are you after a workout?

Are there any specific motions or positions in your daily activity (sport, workouts or work) that are hard to maintain, that create discomfort, are difficult to perform repeatedly or even perform at all?

Do you wear orthotics, or shoe inserts in any of your foot attire and do you consistently use them? Please list the intention behind their use and how you were outfitted for them (were you assessed from a static position or were you moving?)

Do you wear shoes with a moderately high to very high heel? If so, how long do you wear them and what do you do in them? Also please describe how you feel after wearing them.

How much water do you drink in a day (cups/liters) and what percentage of your intake is not water? Please describe.

Do you feel that you maintain a healthy diet? Please provide some detail of a typical day with liquids and solids.

Do you consume alcohol? (How many drinks per day/week)

Do you smoke cigarettes or have you in the last five years? (List frequency and quantity)

Do you sleep 6-8 hours a day including naps?

How do you view your sleep quality — broken and erratic where you wake up tired, solid and deep waking up refreshed, or something in between?

Are you taking any prescription or over the counter medications or have you recently stopped within the last 5 years? If yes, please list their full names, their potential side effects, how long you've taken them and what is the purpose for taking them.

Without providing intimate details, how emotionally stressed do you feel your life is? High, High to Moderate, Moderate, Moderate to Light, or Light? Kindly expound, but only if you feel comfortable sharing.

Have you struggled with any form of Anxiety, Panic Attacks or diagnosed psychological disorders? If so, please expound on your medications or treatments.

Do you have any cardiac, lung or brain related health issues: High or Low Blood Pressure, Arrhythmia, Chronic Obstructive Pulmonary Disease (COPD), Aneurysms or Epilepsy? If so, please expound on your medications or treatments.

Are you pregnant or trying to become pregnant?

Do you currently have a doctor, chiropractor, osteopath, physical therapist, or some other type of therapist? If so, could you provide his or her information so I can maintain open communication on what it is we're working on together?

Are you taking any medications or supplements (over the counter or prescription)?

What is the best way you learn information? (Auditory-listening, Kinesthetic-hands on, or Visual where you need to see models or material related to the subject)

What is the most important thing you want as an outcome by seeing me as a personal trainer and muscular specialist?

(Optional) Kindly upload any medical reports or health documents you'd like to share with Jeremy for your PARQ evaluation.

Waiver of Liability and Informed Consent

I acknowledge that I am voluntarily participating in personal training sessions provided by Performance Breath Training. I understand that physical activity involves inherent risks, including but not limited to injury, and I assume full responsibility for any such risks. I confirm that I have disclosed any relevant health conditions and have consulted a physician if needed. By signing below, I release Performance Breath Training and its trainers from any liability for injuries or damages resulting from my participation.

Your Signature

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Thank you for taking the time to fill out your PARQ form.

We're excited to get the ball rolling!

Performance Breath Training x Jeremy Warner