TOP FLIGHT FITNESS BOOT CAMP Questionnaire

Name:________________________________________________________________
Date:_________________________________________________________________
Address:______________________________________________________________
Home Phone: _________________________ Cell Phone: ______________________
Age:_________
Email Address:_________________________________________________________
Occupation:____________________________________________________________
Describe your health and fitness goals:_____________________________________________
____________________________________________________________________________
____________________________________________________________________________
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Are you currently exercising? List Type of Activity, Days/Week, & Minutes/Day:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
How long have you been exercising
regularly?____________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Do you know the following information?
Total Cholesterol ___________ HDL Cholesterol ______________ Blood Pressure__________
Do you have any significant medical concerns that would impact your ability to exercise?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Do you smoke? ________________ If so, how long? _________________________________
Who is your physician? _________________________________________________________
Date of last physical? __________________________________________________________
Muscular skeletal Issues (Feet, Hips, Back
etc.):________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Are you currently taking any
medications?_________________________________________________________________
____________________________________________________________________________
Have you recently been injured or undergone surgery?
____________________________________________________________________________
____________________________________________________________________________
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