Which type of traing are you interested in:
Your Name:
Your Email:
Your 10 Digit Phone Number (no spaces or dashes):
Have you ever been diagnosed with cardiovascular disease (heart attack, stroke, etc.)?
Have you ever been diagnosed with pulmonary disease (emphysema, bronchitis, asthma)?
Have you ever been diagnosed with metabolic disease (thyroid, kidney, liver)?
Have you ever been diagnosed with diabetes? If so, type 1 or type 2?
Is your resting blood pressure greater than or equal to 140/90?
Do you have high cholesterol?
Do you have a family history of heart attack or sudden death in parents or siblings prior to age 55?
Have you ever had any lower back or neck problems?
Do you have any other muscle, bone, or joint constraints that could be aggravated by physical exertion?
Are you a current smoker? If so, how much (per day)?
Do you experience dizziness or fainting?
Do you use drugs or alcohol?
Are you currently taking any dietary supplements?
Are you taking any medications?
Are you currently under the care of a physician for any reason?
Does your doctor know you are beginning an exercise program? If so, does he object?
Are you aware through your own experience, or physician’s advice, of any other reasons against your
exercising without medical supervision?
Release:
By typing the word "confirm" below, I certify that all responses to the questions above are true and answered to the best
of my ability.
