Sports and Fitness Performance Registration/Medical Forms
Welcome to Sports and Fitness Performance!

On behalf of Sports and Fitness Performance, I welcome you to the program and wish you every success here.

We believe that each person contributes directly to our growth and success.  As you gain an understanding of what Sports and Fitness Performance has to offer, we hope you share our passion for excellence in reaching your health and performance goals.

In order to maximize your experience at Sports and Fitness Performance, please bring the following items for your sessions:

• Cross Trainer Shoes – Make sure the cross-trainers are comfortable with good stability and no air pockets.  As secondary shoes, you may bring running shoes.

• Workout Clothes – Shorts and t-shirts are the most optimal clothing.  Workout pants are also appropriate during the winter months.

Please contact me if you have any additional questions or concerns.

Sincerely,

Frank M. Dolan, BS, CSCS
coachfrankdolan@gmail.com
phone: 631.650.7140

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Last Name *
First Name *
Email Address *
Mobile Phone *
PERSONAL INFORMATION
Date of Birth (mm/dd/yyyy) *
Age *
Gender
Marital Status
Emergency Contact Name *
Emergency Contact Mobile Number *
Emergency Contact Relation *
PAST MEDICAL HISTORY
Have you ever had an injury before?
If yes, please list your injuries (most recent first):
Check which apply to your current condition:
Have you had a surgery related to any of your injuries?
If yes, please specify the date and type of surgery:
If you are female, is it possible you are pregnant?
Do you have, or have you had, any of the following:
If you checked any of the items above, please briefly explain and give the date.  Include any other pertinent information regarding your past medical history:
Do you have any allergies (including medicines or supplements)?
If yes, please explain:
Are you presently taking any medication?
If yes, please list the medication and what condition it is for:
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