Welcome
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About
Blog
Contact Regarding Assessment
Welcome
New Page
About
Blog
Contact Regarding Assessment
Inner Strength Fitness
Ignite your Inner Strength
Contact for Assessment
Name
*
First Name
Last Name
Email Address
*
Age
*
Gender
Female
Male
Transgender/Other Identification
Check if you experience any of the following:
*
Metabolic Diseases (e.g. diabetes, thyroid, etc)
High Blood Pressure
High Cholesterol
Chest Pains
Irregular Heart Beats
Pulmonary Diseases (asthma, etc)
Cardiac Diseases (heart problems)
Smoke Cigarettes
Dizziness
Leg pain due to excessive weight
History of fainting
Snoring/Sleep Apnea
Shortness of breath
Pregnancy
Family history of heart problems
Doctor has advised you not to exercise
Please explain any current or past orthopedic problems that have caused any issues/pain (e.g. shoulder problems, torn ACL, etc):
*
What are your fitness/health/lifestyle goals? How do you plan on achieving them?
*
Profile
Occupation:
*
Briefly explain your current exercise program:
*
How many hours a day are you sitting?
*
0-3
4-6
6+
How many hours per night do you sleep?
*
0-6
7-8
8+
Contact Information
Phone Number
*
(###)
###
####
Which times of day are best for you to meet/train?
*
Morning
Afternoon
Evening (after 5)
Weekends only
How did you hear about Inner Strength Fitness?
*
Is there any additional information about yourself that you would like to share?
Thank you!
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