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.

Name

Address

Contact phone

Phone (cell or work)

Emergency Contact: Name and phone

Age

Height

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

	diabetes
	overweight
	heart disease
	thyroid condition
	cancer
	heart palpitations
	high cholestorol
	heart attack
	No medical conditions that limit training or exercise