Horizon Fitness Training
Pre-Exercise Questionnaire — Please complete to help us tailor your fitness program.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Do you have, or have you ever had, any of the following conditions?
*
Heart disease or chest pain
High blood pressure
Diabetes
Asthma or breathing problems
Joint or bone problems
Dizziness or fainting
Other (please specify)
Are you currently taking any medication? If yes, please specify.
How would you describe your current physical activity level?
*
Inactive
Lightly active (1-2 days/week)
Moderately active (3-4 days/week)
Very active (5+ days/week)
What are your main fitness goals?
*
Lose weight
Build muscle
Improve endurance
Increase flexibility
General health
Other (please specify)
Is there anything else we should know about your health or fitness?
Submit Questionnaire
Should be Empty: