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MEMBER INFORMATION SHEET


Male
Female

YOUR HEALTH AND FITNESS HISTORY

  • YesNo
    1). DO YOU HAVE A HISTORY OF HEART TROUBLE?
  • YesNo
    2). DO YOU FREQUENTLY HAVE PAINS IN YOUR HEART AND/OR YOUR CHEST?
  • YesNo
    3). DO YOU OFTEN FEEL FAINT OR EXPERIENCE DIZZINESS?
  • YesNo
    4). DO YOU HAVE BONE OR JOINT PROBLEMS (ARTHRITIS, OSTEOPOROSIS, ETC.),
    WHICH COULD BE MADE WORSE BY EXERCISING?
  • YesNo
    5). DO YOU REGULARLY HAVE HIGH BLOOD PRESSURE?
  • YesNo
    6). IS THERE ANY REASON NOT MENTIONED WHY YOU SHOULD NOT EXERCISE?
  • YesNo
    7). MEDICATIONS YOU CURRENTLY TAKE WHICH MAY INFLUENCE EXERCISE?
  • YesNo
    MEDS:

OFFICE USE ONLY


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body builders gym

Address:

2516 Hyperion Ave
Los Angeles, CA 90027

Open Hours:

5am-11pm Monday-Friday
7am-9pm Saturday
8am-8pm Saturday

Call Us:

+323 668-0802

Have Any Questions?

info@bodybuildersgym.com