Health Form

  • Physician Information

  • Health & Fitness Information

  • Health History To help keep you safe while designing your exercise program, it is important to know your health history. Please complete the following information to the best of your ability. Describe any pre- existing conditions or past injuries that might affect your participation.
  • For your safe participation in an exercise program, if TWO or more of the above responses are “YES” or if you are pregnant, a consultation with your physician may be necessary prior to participation. Please return a completed Physician’s Referral and Authorization from if appropriate.
  • Muscle and Joint Conditions: