Fitness Assessment Form

Please complete the form below to the best of your ability.

Note: Required fields are marked with an asterisk (*)

Contact Details

We will never sell or disclose your email address to anyone.

Male Female
Yes No
feet  inches
lbs.

Provide days, times, weekends, etc.

Please be as detailed as possible

What was the outcome of your training? What did you like or not like about their method(s)?

Generic Medical History

NOTE: No identifiable information will be asked, these are general health questions so we can better assess your fitness capabilities.

MM / DD / YYYY

i.e. Arthritis, Cancer, Joint Problems, High Blood Pressure, Diabetes, Back Pain/Injury, High Cholesterol, etc.

Eating, Work, & Exercise Habits
Yes No
times per day
hours (approximately)

Sitting at your desk most hours, on the phone, walking around a warehouse, etc.

i.e. Walking, jogging, swimming, climbing stairs, etc.

i.e. Weight lifting, pushups, pullups, etc.

Other information
Are you currently a member of gym? If so, where? *
Email Telephone Doesn't Matter
Please indicate if you are interested in any of the following services:









Verify & Submit

Please enter the code as you see in the image above.