FTNS Personal Training Check-in Form

1
Your Name* This field is required.
First Name
Last Name
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Date and Time* This field is required.
Date
Month
Day
Year
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Hour
40
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Minutes
PM
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PM
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Have you experienced any of the following in the last 24 hours? * This field is required.Do you have a Fever (temperature over 100.30F) without having taken any fever reducing medications? Do you have a Loss of Smell or Taste? Do you have a Cough? Do you have Muscle Aches? Do you have a Sore Throat? Do you have Shortness of Breath? Do you have Chills? Do you have a Headache? Have you experienced any gastrointestinal symptoms such as nausea/vomiting, diarrhea, loss of appetite? Have you, or anyone you have been in close contact with been diagnosed with COVID-19, or been placed on quarantine for possible contact with COVID-19? Have you been asked to self-isolate or quarantine by a medical professional or a local public health official?
YESNO
4
Signature* This field is required.
Clear
5
Please Show the Trainer Your Phone:
6
Please Show the Trainer Your Phone:
Should be Empty: