Fit4U New Client Form Please fill out this form as accurately and completely as possible to help us learn more about you in order to customize your training plan. Name*FirstLastDate Email*Enter EmailConfirm EmailPhone*AddressStreet AddressAddress Line 2CityState / Province / RegionZip / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryHeight (in.)Weight (lbs.)AgePhysician's NameFirstLastPhysician's PhonePhysical Activity Readiness Questionnaire (PAR-Q)Has a doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*YesNoDo you feel pain in your chest when you perform physical activity?*YesNoIn the past month, have you had chest pain when you were not performing any physical activity?*YesNoDo you lose your balance because of dizziness or do you ever lose consciousness?*YesNoDo you have a bone or joint problem that could be made worse by a change in your physical activity?*YesNoIs your doctor currently prescribing any medication for your blood pressure or for a heart condition?*YesNoDo you know of any other reason why you should not engage in physical activity?*YesNoIf you have answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. General & Medical QuestionnaireWhat is your current occupation?Does your occupation require extended periods of sitting?*YesNoDoes your occupation require extended periods of repetitive movements?*YesNoIf yes, please explain.Does your occupation require you to wear shoes with a heel (dress shoes)?*YesNoDoes your occupation cause you anxiety (mental stress)?*YesNoDo you partake in any recreational activities (golf, tennis, skiing, etc.)?*YesNoIf yes, please explain.Do you have any hobbies (reading, gardening, working on cars, exploring the Internet, etc.)?*YesNoIf yes, please explain.Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)?*YesNoIf yes, please explain.Have you ever had any surgeries?*YesNoIf yes, please explain.Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes?*YesNoIf yes, please explain.Are you currently taking any medication?*YesNoIf yes, please list.Additional InformationPlease take a moment to tell us about any other questions or concerns you may have about working out.