**The purpose of this form is to screen new members for any potential life threatening conditions that may be worsened through exercise. This helps us properly design and implement an exercise program that is still tailored to the individual's goals, but more importantly safe for the member to do.  We do NOT sell or share this information. It is for the sole use of safe exercise design ONLY.  This form should take 5-15 minutes to complete.  

**This questionnaire will ask about any current medication use and ask for information from your most recent lipid panel/blood work.  If you do not know this information from memory, please take some time to find it prior to starting the questionnaire. If you do not have this information/not accessible/unknown, it is not required to finish the form.

We will retain any paper forms for a period of 6 months for any inactive members before destroying copies.  Should any of the information provided by yourself change, please inform your trainer so that we can appropriately adjust your program as needed.

If you are under 18, you will need a parent, legal guardian, or care provider's signature of approval and acknowledgement as well.