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Gold Level Start Up

Step 1


 



Please tell us about yourself. Once you submit your start up questionnaire your coach will contact you to set up an interview and discuss your answers. All questions indicated with an * are required for completion.

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

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