Contact Form
Please contact ptfitnessbootcamp@sbcglobal.net OR call 817-653-7272
for questions or to set up a consultation.

E-mail Address: *
Name *
Phone Number *
Address *
Height
Age *
Weight *
Are you primarily interested in joining a boot camp or personal training? *PT Fitness boot camps
Personal Training
Id like to discuss both
How would you rate your current fitness level?
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?Yes
No
Do you feel pain in your chest when you perform physical activity?Yes
No
In the past month, have you had chest pain when you were not performing any physical activity?Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?Yes
No
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?Yes
No
Do you know of any other reason why you should not engage in physical activity? If yes, please explain.
What is your current occupation?
Does your occupation require extended periods of sitting?Yes
No
Does your occupation require extended periods of repetitive movements?Yes
No
Does your occupation require you to wear shoes with a heel (dress shoes)?Yes
No
Does your occupation cause you anxiety (mental stress)?Yes
No
What, if any, recreational activities (golf, tennis, skiing, etc.) or hobbies (reading, gardening, working on cars, exploring the Internet, etc.) do you participate in?
Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)? If yes, please explain.Yes
No
Have you ever had any surgeries? If yes, please explain.
Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes? If yes, please explain.
Are you currently taking any medication? If yes, please list.
Is there any other medical information you would like to share?
What is your main fitness goal?
* Required
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