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Medical Intake Form

Medical Intake & Liability Acknowledgement

This Medical Intake Form is required for all participants engaging in training, programs, classes, or services offered by FNK Fitness. The information provided helps ensure a safe and supportive training experience. By completing this form, I confirm that all information shared regarding my medical history, injuries, conditions, and physical or psychological concerns is accurate and complete to the best of my knowledge.

I understand that participation in fitness training and physical activity involves inherent risks, including but not limited to injury, illness, accidents, falls, physical contact with other participants, and environmental factors such as heat or weather conditions. I voluntarily assume full responsibility for any risks, injuries, or damages that may occur as a result of my participation.

I acknowledge that it is my responsibility to communicate any medical conditions, injuries, or limitations that may affect my ability to safely participate. I confirm that I am physically and mentally capable of engaging in the activities I choose to participate in at FNK Fitness.

By submitting this form, I agree to release and hold harmless FNK Fitness, its owners, instructors, employees, and representatives from any and all liability, claims, demands, or causes of action arising from participation in training, programs, or events, including any injury sustained during or after sessions.

I understand that this document serves as both a medical intake acknowledgment and a waiver of liability, and I voluntarily agree to its terms.

Birthday
Year
Month
Day
How much of your day do you spend sitting, in the office or in the car?
Rarely
Occasional (1-2hours per day)
Moderately (4-6hours per day)
Mostly (more than 6 hours a day)
What’s your 'why' for fitness? (Check all that apply)
What is Your Fitness Background? (check all that apply)
Any previous injuries?
Yes
No
If yes, please check all that apply
Are you Pregnant?
Yes
No
Maybe
Do you smoke? (weed or tobacco)
Yes
No
Do you drink alcohol?
Yes
No
Medical History: (check all that apply)
Activity Level and Nutrition: What is your activity Level (Physical activity outside of work)
How much water intake?
How many cups of coffee (caffeine) do you drink per day?
Do you eat 3 meals a day?
Yes
No
Do you eat before your workout?
Yes
No
I don't workout right now
Do you eat after your workout?
Yes
No
I don't workout right now
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