Location *

Where would you primarily like to work out?

In Studio

At Home

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Alternate Phone Number

(###)

###

####

Birth Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

When was your last medical checkup? *

MM

DD

YYYY

Do you smoke? *

Yes

No

Have you ever experienced chest pains while exercising? *

Yes

No

Do you have high blood pressure? *

Yes

No

Do you have any heart conditions? *

Yes

No

Do you ever lose balance because of dizziness or lose consciousness? *

Yes

No

Do you have any muscle, bone, or joint conditions? *

Yes

No

Do you suffer from back pain or any other pain? *

Yes

No

Have you had any surgery in the past two years? *

Yes

No

Do you know of any other reason why you limit or avoid phyiscal activity? *

Yes

No

Do you have any of the following conditions? *

Arthritis

Asthma

Diabetes

None of the above

Monday

6:30AM - 8AM

8AM - 11AM

12PM - 4PM

5PM - 8PM

Tuesday

6:30AM - 8AM

8AM - 11AM

12PM - 4PM

5PM - 8PM

Wednesday

6:30AM - 8AM

8AM - 11AM

12PM - 4PM

5PM - 8PM

Thursday

6:30AM - 8AM

8AM - 11AM

12PM - 4PM

5PM - 8PM

Friday

6:30AM - 8AM

8AM - 11AM

12PM - 4PM

5PM - 8PM