Your Info

Please tell us more about yourself! Complete every question to the best of your ability.

Name

First Name

Last Name

Issues

Do you have any medical or orthopedic issues that could impact your ability to exercise?

Doctor Care

Are you currently under a doctor's care for any condition? If yes, please explain.

Chest Pain or Dizzyness

Do you ever have chest pain or dizziness upon physical exertion? If yes, please explain.

Medications

Are you currently taking any medications? If yes, please list.

Exercise Routine

What is your current exercise routine?