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| Emergency Contact |
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Work Phone |
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| Please select your location: |
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| Please select your time: |
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| Promo Code: |
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| Voucher: |
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| Health Questionnaire |
1. Has a doctor diagnosed you with any heart conditions?
Examples include: mitral valve prolapse, myocardial infarction, angina, dysrhythmia, atherosclerosis of the coronary artery. |
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2. Has a doctor diagnosed you with any obstructive pulmonary disease?
Examples include: asthma, interstitial lung disease, emphysema, bronchitis, cystic fibrosis. |
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3. Has a doctor diagnosed you with any form of metabolic disease?
Examples include: diabetes mellitus (type 1 or type 2), thyroid disorder, renal or liver disease. |
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| 4. Have you been diagnosed by a doctor as hypertensive (high blood pressure)? |
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| 5. Have you been diagnosed by a doctor as having high cholesterol? |
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| 6. Have you been diagnosed by a doctor as having high triglycerides? |
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| 7. Are you epileptic? |
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| 8. Do you smoke (or have you quit within the last 6 months)? |
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| 9. Are you pregnant? |
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| 10. Are you pre or postnatal? |
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| 11. Do you consider yourself having a sedentary lifestyle (i.e. do you sit a large part of your day)? |
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| 12. Have you ever experienced chest pain? |
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| Or you may drop us an email at: fit@columbiabootcamp.com |
