Gold Level Start Up

Step 1

Please tell us about yourself. Once you submit your start up questionnaire your coach will contact you to set up an interview and discuss your answers. All questions indicated with an * are required for completion.

General / medical information

Name

Address

Contact phone

Other phone (cell,work, or home)

Emergency Contact: Name and phone

Age

Height

Weight

10.

Body fat (percent)

11.

Resting heart rate

12.

Blood pressure

Please list any muscular skeletal injuries you have experienced. Include type of injury, date, and treatment. Be specific.

13.

Sports Injuries

Please check if you have any of the following medical conditions

14.

Medical Conditions

	diabetes
	overweight
	heart disease
	thyroid condition
	cancer
	heart palpitations
	high cholestorol
	heart attack
	No medical conditions that limit training or exercise
	smoker