Health Questionnaire

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Full Name

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Phone Number

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url

What PRESCRIPTION Medication do you take?(Required)

How Concerned are you about failing?(Required)

Are you currently experiencing any physical limitations that could affect your training plan?(Required)

What PRESCRIPTION Medication do you regularly take?(Required)

Do you smoke tobacco products?

Yes

Which of the following health conditions (if applicable) have you been told that you have EVER had?(Required)

Are you able to walk 10 minutes on your own?(Required)

Rate your experience with exercise(Required)

Beginner

Intermediate

Advanced

What are your health / fitness goals?(Required)

How would you rate your health?(Required)

What type of exercises are your interested in?(Required)

Balance exercises that help prevent falls

Flexibility exercises that stretch your muscles and help your body stay limber

Strength exercises that make your muscles stronger and toned

Endurance or aerobic activities that increase your breathing and hearth rate

If currently exercising please describe your activities(Required)

THANK YOU!