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Live Oak Strength Health History & Intake
Please complete our health history and intake form so your trainer has ample time to review it and design a great personalized workout for you. We look forward to meeting you. Thank you!
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First and Last Name:
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Your answer
Prefer to be called:
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Your answer
Hobbies/Interests:
Your answer
If Applicable: Spouse's Name
Your answer
If Applicable: Children's/Pet's name:
Your answer
Emergency contact: (name, phone, relationship)
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Your answer
Your Occupation:
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Your answer
Current Physical Activities (type of activity, how often?):
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Your answer
Why do you want to strength train? What do you hope to accomplish by training at Live Oak Strength?
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Your answer
Have you ever strength trained before? If yes, where, when, how long, what did you like about the process?
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Your answer
CONDITIONS- please check all that apply:
Do you have any history of heart problems?
Do you have a current heart condition?
Have you ever had a heart attack or stroke?
Have you ever experienced chest pain?
Do you have high or low blood pressure?
Do you have arthritis?
Do you have high cholesterol?
Are you pregnant now or within the last 3 months?
Any medical procedures within the last 12 months?
Do you experience dizziness or fainting?
Do you have asthma or any respiratory problems?
Do you have Diabetes or a thyroid condition?
Do you have or have had a hernia of any kind?
Are you taking any medications?
Do you have a chronic illness or condition?
If you selected any of the above conditions, please supply as much detail as possible in this section:
Your answer
INJURIES/OTHER - please check all that apply:
Have you ever had any lower back problems?
Do you have any neck problems?
Do you have any shoulder issues?
Do you have or have you had any other joint or muscles issues, surgeries?
Are you currently under the care of a physician for any reason at all?
Do you smoke cigarettes, cigars, or other?
Do you use drugs and/or alcohol?
If you selected any of the above, please supply as much detail as possible in this section:
Your answer
Do you know of any other physical or mental condition that you have or have had that could be aggravated, worsened, exacerbated, inflamed, etc. by exercising or exerting yourself?
Your answer
Is there anything else you'd like to share with us before we meet for your introductory workout?
Your answer
I have read, understood and completed the questionnaire. By selecting 'Agree' it will act as my signature on this questionnaire.
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Agree
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