Submit WOMEN CLASS – BXGFIT

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fILL UP THE FORM

STEP 2 OUT OF 3

ZOOM CLASS

Name *

First

Last

Gender *

Date of birth

First

Last

Phone *

Your Fitness Goals

Weight Loss
Fat Loss
Endurance
Flexibilty
Muscular Strength
Appearance
Fitness
General Conditioning
Toning & Shaping
Posture

Do you exercise regularly?

I have never exercised regularly
I used to exercise regulary
I exercise every now and then
I currently exercise regularly

Do you have any diagnosed health problems

Asthma
Arthritis
Heart disease
Lung disease
High blood pressure
Low blood pressure
Shortness of breath
Blood cholesterol
Thyroid condition
Diabetic

Please list any current or past injuries that could prevent certain activities:

Back Problems
Muscle disorder
Joint dislocation
Tendon/ Ligament Tear
Recent Surgery (last 12 months)

Rate your overall activity level?

Inactive
Moderately active
Active
Very active

Where do you usually workout

Gym
Home
Outdoor

Are you a smoker

Yes
No

Are you pregnant

Yes
No

Message

Clients say