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My Health information

Please fill out this form. Not only will it give us an accurate picture of your current health, but it will help us and the trainer determine your needs during our workouts. We must have this information before you attend a class or become a member.

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PERSONAL INFO

 
First Name * Last Name *
Gender * Birthday *
Email * Confirm Email *
Password * Confirm Password *
Company How did you hear about us? *
   

Your Address

  
Mailing Address * Postcode *
City * State *
Country *  
 
Mobile *
 
   

Free Trial

  
Sign up for a Free Trial? * Free Trial Location *
Have you done outdoor group training before? *
   
 
* Required field  
   

FITNESS PROFILE

 
1. Occupation *  
 
2. High heels / Orthopedics *  
 
3. Repetitive movement *  
 
4. Sitting percentage *  
 
5. Sport or Recreational activities *
 
6. Have you ever had any serious pain or injuries? *  
 
If yes, please explain  
7. Any surgeries / rehabilitation for said pain / injuries? *  
 
If yes, please explain  
8. Do you have any existing / family history of medical conditions? *  
 
If yes, please explain  
9. Are you currently taking any medication? *  
 
If yes, please explain  
10. Is there any reason not yet mentioned for you to not exercise? *  
 
If yes, please explain  
11. Why are you here? Why do you want to exercise? *  
Please explain  
12. Maximum Aerobic Function (180 - Age) *  
 
   
 
* Required field  
   

Do you suffer from any of the following?
 
1. Heart disease
13. Asthma
2. Heart Condition
14. Diabetes
3. Back pain
15. Epilepsy
4. Spinal Injuries
16. Hernia
5. Arthritis
17. Heart Palpitations
6. Joint pains
18. Hi/low Blood Pressure
7. Tightness in Chest
19. Rheumatic Fever
8. Liver/Kidney Condition
20. Regular Headaches
9. Infections
21. Muscular pain/cramps
10. Chronic Cough
22. High Cholesterol
11. Are you pregnant?
23. Allergies to Grass?
12. Bladder Weakness?
 
24. Additional Comments/Information
 
* Required field