Health Assessment Form
Provide your unique health profile to The Fitness Department, by completing the information below. This form must be submitted before participating in your first class with The Fitness Department. Your personal information will remain strictly confidential. Please refer to the Privacy Policy (found at the footer of this website) for more information. Your unique fitness history will help The Fitness Department create modifications, alternatives, and successful movement exercises to help strengthen and stretch your fitness experience with us. Thank you!

Please note: If completing this form on a mobile device, please rotate your phone to landscape (horizontal) mode to finish completing the form if needed. Thank you.
First and Last Name *
Residential Address, City, State, ZIP *
Mobile Phone *
Email *
How do you prefer to be contacted by us? *
Required
How did you hear about us? *
Emergency Contact, Relationship, Phone number *
Height (inches) *
Weight (lbs) *
Birth date *
MM
/
DD
/
YYYY
Gender *
Medical doctor and direct phone number: *
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