Fitness Goals & History

What Is Your Biggest Goal You Are Trying To Achieve?

Decrease Body FatImprove StrengthGain MuscleWeight LossImprove HealthOvercome Injury

Are You Currently Active Or Lifting Weights?

YesNo

Do You Have Access To a Public Or Home Gym?

YesNo

Lifestyle

Is Anyone In Your Family Overweight?

YESNo

Are You Overweight?

YesNo

If Overweight, Have You Always Been Overweight?

YESNoDoes Not Apply

Health/Injuries

Are There Any Injuries That Need To Be TAKEN INTO CONSIDERATION FOR YOUR EXERCISE PROGRAM?

YesNo

Miscellaneous

I recognize that in preparing this questionnaire I have disclosed true accurate and fair information about my health. Upon receipt of my plan I agree to confirm with my physician that I am medically cleared to engage in this type of athletic program. I understand that providing false information and failing to seek a medical opinion as to my ability to carry out these plans could result in serious bodily injury and even death. Please carefully review any provided plans against your existing food allergies. It is your responsibility to verify that the plan does not use foods that you may be allergic. While we attempt to tailor your plans to meet your dietary needs the ultimate burden of ensuring that you do not eat a food with which you may have an allergy rests with you. I understand that these plans are not a medical service and have not been reviewed by a medical doctor or health care professional and we do not warrant them as being reviewed by such. I specifically agree to indemnify and release LIFE RENU from any injury resulting from a discrepancy in this questionnaire or from my own failure to seek medical advice to verify my ability to engage in the athletic plan.I understand and appreciate that these plans require proper supervision by a doctor. I agree to review this plan with my doctor or otherwise indemnify LIFE RENU from any liability from using this plan without a doctor. I specifically understand that LIFE RENU does not have doctors on staff and that this service is provided to be used in conjunction with proper medical guidance.