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FRESH START FITNESS QUESTIONNAIRE

Personal Exercise Goals

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Have you ever had or suffered from any of the following medical conditions?

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Heart Disease:

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Respiratory Disease:

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Other:

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IF YOU ANSWERED YES TO ANY OF THE FOLLOWING QUESTIONS YOU MUST GET WRITTEN CONSENT FROM YOUR PHYSICIAN BEFORE RECEIVING ANY PERSONAL TRAINING ADVICE.

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Have you ever followed a physical fitness program?

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How much time do you have available to exercise?

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