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Please complete prior to training start date.

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If under age 18 a parent or legal guardian signature required.

ATHLETE INTAKE QUESTIONNAIRE

Athlete Intake Questionnaire

Agent Info (if applicable)

Sport & Training

Health History

Do you have any CURRENT injuries or physical therapy we should be aware of?
No
Yes
Have you had PREVIOUS surgery or a serious injury?
No
Yes
Do you have any known allergies?
No
Yes
Have you ever been diagnosed with a heart condition?
No
Yes
Do you experience chest pain during physical exertion?
No
Yes
Do you have high or low blood pressure?
No
Yes
Do you have asthma or other respiratory issues?
No
Yes
Do you have diabetes or any metabolic diseases?
No
Yes
Any other medical conditions or physical limitations we should be aware of?
No
Yes

Consent

I, the undersigned, affirm that the information provided above is accurate to the best of my knowledge. I understand that it is my responsibility to consult with a physician prior to participating in any exercise program.

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