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New Member Questionnaire
If you are interested in training with one of our trainers please fill out this form and we will get in touch with you shortly.

  1. Name:*

  2. Date you would like to start:

  1. Phone:*

  2. Email:*

  1. Height:

  2. Weight:

  3. Age:

Do you have a bone or joint problem that could be made worse by a change in your physical activity?
YesNo

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
YesNo

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
YesNo

Do you feel pain in your chest when you perform physical activity?
YesNo

In the past month, have you had chest pain when you were not performing any physical activity?
YesNo

Do you lose your balance because of dizziness or do you ever lose consciousness?
YesNo

Do you know of any other reason why you should not engage in physical activity?
YesNo

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123 South El Camino Real
San Clemente, CA. 92672
949.361.1007
sanclementegym@att.net