Join Us at JP4 Fitness
The Personalised Over 50s Gym
Name
*
First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Date of Birth
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Month
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Day
Year
Date
Gender
Female
Male
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Medical Hsitory
Has your doctor ever said you have a heart condition or high blood preasure
*
Yes
No
Are you receiving treatment for any diagnosed medical condition?
*
Yes
No
Please explain if yes
Have you ever been diagnosed with another medical condition other than heart disease or high blood pressure?
*
Yes
No
Please Explain if yes
Do you have any medical conditions or injuries?
*
Yes
No
Please explain if yes
Primary Fitness Goal
What is Aim?
*
Lose weight
Build muscle
Increase flexibility
Improve general health
Improve Strength
Training for an event
To feel better
Rehabilitation from injury or surgery
Other
How would you rate your current fitness level?
*
Beginner
Intermediate
Advanced
What types of exercise do you enjoy? (Select all that apply)
*
Cardio - Run/Walk/Bike/Row/Cross trainer
Strength Training
Other
Please list any additional information or preferences that would help us tailor your plan:
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