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About
Acroyoga
Weight Loss
Class Schedule
Memberships
Contact Us
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Health History
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Name
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First
Last
Email
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Phone Number
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How did you hear about us?
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How would you rate your current fitness level?
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Beginner
Intermediate
Advanced
Please answer "yes" or "no" to the following questions:
Has your doctor ever said you have a heart condition and that you should only do physical activity prescribed by a doctor?
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Yes
No
Have you been restricted to physical activity prescribed by your doctor?
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Yes
No
Do you feel pain in your chest when you do physical activity?
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Yes
No
In the past month, have you had pain in your chest when you are not doing physical activity?
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Yes
No
Do you lose your balance because of dizziness or do you lose consciousness?
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Yes
No
Is your doctor currently prescribing drugs for your blood pressure or heart condition?
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Yes
No
Do you have bone or joint problems that could be made worst by a change in physical activity?
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Yes
No
Any previous injury still affecting you?
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Yes
No
Any chronic illness or condition?
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Yes
No
Is there any other reason why you should not participate in physical activity?
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Yes
No
Submit