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Start Up Kit

Step 1 Please tell us about yourself. Once you submit your start up questionnaire your coach will contact you to set up a consultation and discuss your answers in detail. All questions indicated with an * are required for completion.

 

General / medical information * 1. Name

* 2. Address

* 3. City, State, Zip

* 4. Email

* 5. Contact phone

6. Other phone (cell,work, or home)

7. Emergency Contact: Name and phone

* 8. Age

* 9. Height

* 10. Weight

11. DOB

12. Body fat (percent)

13. Resting heart rate

14. Blood pressure

Please list any muscular skeletal injuries you have experienced. Include type of injury, date, and treatment. Be specific.   15. Sports Injuries

Please check if you have any of the following medical conditions   16. Medical Conditions

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

17. Surgery in the last year? Please be specific

18. Do you ever experience back or neck pain? If so, please explain.

19. Do you have any condition that will limit high intensity exercise?

No  Yes (please explain)

20. Medications or supplements you are taking.

21. Last Physical Exam (date)

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