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New Client Form

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What services are you interested in?
How did you hear about us?

Revised Physical Activity Readiness Questionnaire (PAR-Q)

Please answer Yes or No to the following questions:

Has a doctor ever said that you have a heart condition and recommended only medically supervised activity?
Yes
No
Have you ever had angioplasty, cardiac bypass, or stints?
Yes
No
Do you have chest pain brought on by physical activity?
Yes
No
Have you developed chest pain in the past month?
Yes
No
Have you on one or more occasions lost consciousness or fallen over as a result of dizziness?
Yes
No
Do you have a bone or joint problem that could be aggravated by physical activity?
Yes
No
Has a doctor ever recommended medication for your blood pressure or a heart condition?
Yes, my blood pressure is controlled withing a normal range
Yes, but my blood pressure is GREATER than 145/90 mm Hg
No
Are you aware, through your own experience or a doctor’s advice, of any other physical reason that would prohibit you from exercising without medical supervision?
Yes
No

Agreement and Release of Liability

In consideration of being allowed to participate in physical activity and the use of the services of Fitness Beyond Training, LLC, I do hereby knowingly and voluntarily forever waive, release, and discharge any or all claims or liabilities for injuries or damages to my person and/or property arising out of or connected to my participation in any activities or programs given by the fitness professionals of Fitness Beyond Training, LLC

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I have been informed, understand, and am aware that exercise, including the use of exercise equipment, is potentially hazardous. I am voluntarily participating in these activities and understand the dangers involved. I hereby agree to expressly consume and accept any or all risks of injury or death.

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I do hereby consider myself to be physically sound and suffer from no condition, impairment, disease, infirmity, or other illness that would prevent my participation or use of exercise equipment. I do hereby acknowledge and have been informed of the need for a physician’s approval for my participation in exercise activities, programs, and use of exercise equipment. I acknowledge that I have either been given my physician’s approval to exercise or that I have decided to participate in exercise activities without the approval of my physician and do hereby assume all responsibility for my participation in these activities, programs, and use of any equipment.

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Health History

Indicate any recent or past areas of pain, discomfort, health issue, or disease:

Restrictions, Limitations, or Health Issues
Select Areas of Previous or Current Pain, Discomfort, or Injury

Exercise History

How frequently have you been exercising in the last four months? What type of exercise? (ex: cardio, strength, CrossFit, classes, boot camp, etc.)

Approximate date of last exercise session:
Month
Day
Year

Nutrition History

Add your text

Sleep and Recovery

Health, Fitness, and Performance Goals

Client Acknowledgment & Verification

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