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Sweat Reign: Fitness Assessment
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SWEAT REIGN L.C.
Name
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Your answer
Date
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MM
/
DD
/
YYYY
Email
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Your answer
Phone number
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1 point
Your answer
Age
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Your answer
Check all that applies to you
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Recent surgery
Chest Pain
Hypertension
Stroke
Diabetes
Lung Injury/Issue
Muscle Injury/ Issue
Your doctor has prescribed you ONLY do physical activity recommended by a doctor.
None
Joint/ Bone Injury/ Issue
Heart Condition
Required
If you checked anything from above please use the space below to explain your medical condition(s).
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Your answer
How long have you been exercising regularly (several days a week)?
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6months or less
1-3 years
3-5 years
5 years or more
Fitness goal(s):
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Muscle Endurance
Improve Muscle Tone/ Sculpting
Weight gain
Weight loss
Stress Management
Increase Flexibility
Rehabilitation
Reshape Body
Gain Strength
Improve Cardiovascular Fitness
Required
All payments should be made via Cash, Cash App, or Apple Pay lit your form of payment; how many sessions are you paying in advance?
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Your answer
Desired service
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Yoga/ Guided Meditation/ Spiritual Healing (Afrikka)
High Intensity Interval Training (Coach Hollywood)
Full Yoga/ HIIT training package
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