New Client Questionaire

~Bobbi Chance~
Training Women of all ages
all over the world!

New Client Health Questionaire

Date:

Name:
Date of Birth:
Address (include City/State/Zip Code)
Phone #/ Cell #:
Email address:
Are you currently in a fitness program?:
List any and all concerns you might have regarding starting a fitness program.

Check your fitness goal(s) (Please hold the Ctrl key down to select more than one goal)
List the fitness equipment you have at your home, If none please list none.
Do you currently have a gym membership?
Please check if you have had or you currently have any of these conditions:
		Please read the following terms and conditions before submitting this health questionaire.
		Terms & Conditions: Prior to starting any exercise program, and before you follow any of the advice, instructions, or any other recommendations in this Website, you should first consult with your doctor and have a physical examination. The instructions, recommendations, and advice contained within this Website and Email, are in no way intended to replace or to be construed as medical advice and is offered for informational purposes only.

		I agree to the terms and conditions