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Personal Fitness Training Inquiry Form

  1. (314) 963-5624

  2. Best way to reach you?*

  3. Have you spoken with either:

  4. When do you prefer the training sessions to be? Check all that apply.

  5. Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommend by a doctor?*

  6. Do you feel pain in your chest when you perform physical activity?*

  7. In the past month, have you had chest pain when you were not performing any physical activity?*

  8. Do you lose your balance because of dizziness or do you ever lose consciousness?*

  9. Do you have a bone or joint problem that could be made worse by a change in your physical activity?*

  10. Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?*

  11. Do you know of any other reason why you should not engage in physical activity?*

  12. Does your occupation require extended periods of sitting?*

  13. Do you partake in any regular recreational activities or hobbies (fitness center exercise, golf, tennis, skiing, hiking, gardening, etc?) If yes, please explain below:*

  14. Has a medical doctor every diagnosed you with a chronic disease (coronary heart disease, diabetes, hypertension, high cholesterol, other) If yes, please list below:*

  15. Do you get 7-9 hours of sleep most nights? *

  16. Did you eat breakfast this morning? *

  17. Do others live in your household?*

  18. Leave This Blank:

  19. This field is not part of the form submission.