In Nature Fitness – In Nature Fitness

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[h3]Personal Information[/h3]

My main goal is:

I was referred by:

How did you hear about us?

Name of Emergency Contact

Emergency Phone Number

[h3]Medical History[/h3]

Enter N/A for any section which is not applicable to you.

Are you allergic to any medication? List medications:

Do you take any prescribed medication? List medications:

Do you suffer from epilepsy? List medications:

Are you anemic? List medications:

Do you have Diabetes? List medications:

Do you have High Blood Pressure? List medications:

Do you wear glasses or contact lenses?

Do you have Asthma?

Do you have Heart Disease? List medications:

Do you have Lung Disease? List medications:

Do you have Kidney Disease? List medications:

Do you have Liver Disease? List medications:

Have you ever had a severe neck injury? Describe:

Have you ever been knocked out? Describe:

Have you had a broken bone or fracture in the past 2 years? Describe:

Have you had knee pain in the past 2 years that has disabled you for longer than a week? Describe:

Have you ever injured your back? Describe:

Describe any current pain you may be experiencing:

Do you have other physical conditions which cause pain? Describe:

Have you had any surgical procedures? Describe:

What are your goals for the next three months? Describe:

Have you had your body fat tested? Describe testing and results:

Are you training for a specific event? If yes, explain:

[h3]Release[/h3]

This release is entered into between the undersigned and BABC/In Nature Fitness its officers, subsidiaries, affiliates, and executors...

I agree to all Terms and Conditions

[h3]Signature[/h3]
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