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Training Application Form

Please fill out the following form.

Date of birth
Year
Month
Day
Are you taking any medications?
Yes
No
Has your doctor ever diagnosed you with high blood pressure?
Yes
No
Has your doctor ever diagnosed you with a bone or joint problem that has been or could be made worse by exercise?
Yes
No
Please indicate if you have, or have had, any of the following conditions:
Pain History: Please indicate if you have, or have had, pain in the following:
How serious are you about achieving your goal? 1 = Not motivated, 5 = Very Motivated
1
2
3
4
5
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