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Personal Fitness Training Inquiry Form

  1. Contact:

    (314) 963-5600

  2. Best way to reach you?*

  3. Please complete the following information so we can place you with the trainer who will best meet your needs.

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

  5. Physical Activity Readiness Questionnaire (PAR-Q)

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

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

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

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

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

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

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

  13. General & Medical Questionnaire

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

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

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

  17. Thank you for completing our inquiry form, we will follow up very soon. If you have questions, please contact our Fitness Manager at (314) 963-5623 or clarks@webstergroves.org.

  18. Leave This Blank:

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