WLA Fitness Pre-Assessment

Name *
Phone *
1. Have you experienced any past injuries or sustained illnesses that limit you from performing physically challenging activities? *
2. Do you lose your balance because of dizziness or do you ever lose consciousness? *
3. Are you taking any prescribed medication at this time? *
4. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
5. (Females only) Are you pregnant? *
Choose the one that MOST suits you