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Health Screening Questionnaire

Personal Information

Birthday
Year
Month
Day

Medical History

Please indicate if any of these statements apply to you by clicking the check box.

Skeletal Injuries

Please talk with your doctor by phone or in person before you start any new training program or have a fitness appraisal. Tell your doctor about your health questionnaire and which questions you answered yes.

GOALS

FITNESS HISTORY

LIFESTYLE

How would you describe your level of daily activities?
Light (office work)
Moderate (manual labor)
Heavy (construction)
Stress level
Low
Medium
High
Available or preferred day(s) to train
Time
AM
PM

Client Agreement

As a condition of my enrollment, I accept full and complete responsibility for my own ability to healthfully participate in this program. I understand that participation and use of instruction, programs, activities, services, facilities, and equipment provided by Progress Fit is potentially hazardous. I hereby release Progress Fit, its directors, officers, agents, employees, trainers, management, representatives, their assigns, their heirs, executors, and administrators, and all others from any responsibility or liability for any injury, damage or any loss whatsoever, including those caused by their negligence. I have read and understood the above, and understand that it sets out the terms of engagement, and that it is also a total release, and waiver of liability.

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