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General Fitness Start Up

 



Please tell us about yourself. Once submitted your fitness coach will contact you for a start up interview and to discuss your plan. All questions indicated with an * are required for completion.

* 1. Name
 
* 2. Address
 
* 3. Email
 
* 4. Contact phone
 
  5. Phone (cell or work)
 
  6. Emergency Contact: Name and phone
 
* 7. Age
 
* 8. Height
 
* 9. Weight
 
Please list any muscular skeletal injuries you have experienced. Include type of injury, date, and treatment. Be specific.
  10. Muscular skeletal Injuries
 
Please check if you have any of the following medical conditions
  11. Medical Conditions
 
 
 
 
 
 
 
 
 
 
  12. Blood pressure
 
  13. Surgery in the last year? Please be specific
 
  14. Do you ever experience back or neck pain? If so, please explain.
 
  15. Do you have any condition that will limit high intensity exercise?
 
 
 
  16. Medications or supplements you are taking.
 
  17. Last Physical Exam (date)
 

The Sport Factory • 1750 Founders Parkway, Suite 130, Alpharetta, GA USA 30004-7600 (770) 602-5154
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