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Health Declaration

We are excited that you are considering our sports performance facility and training systems to help you reach your health and fitness goals. In order to provide the best possible care, we require all new clients to complete this medical questionnaire. Your privacy and confidentiality are important to us, and all information you provide will be kept confidential.

Do you have any chronic medical conditions, such as diabetes, heart disease, or asthma?
Have you been hospitalized in the last 12 months?
Are you currently taking any prescription medication?
Have you ever had surgery?
Do you have any allergies?
Have you ever experienced chest pain or shortness of breath during exercise?
Have you ever had a concussion or other head injury?
Have you ever had a seizure or seizure disorder?
Have you ever been diagnosed with a mental health condition, such as depression or anxiety?
Have you ever had an injury to a joint or muscle?
Have you ever had a bone fracture or dislocation?
Do you have any neurological symptoms, such as tingling or numbness?
Do you wear any corrective lenses or hearing aids?
Do you have any joint pain or limited range of motion?
Have you ever had a back injury or pain?
Have you ever experienced dizziness or loss of consciousness during exercise?
Do you smoke cigarettes or use other tobacco products?
Do you consume alcohol?
Do you take any supplements?
Do you use any recreational drugs or performance-enhancing substances?

By signing below, I certify that the above information is accurate to the best of my knowledge. I understand that failure to disclose any relevant medical history or conditions could result in serious injury or harm during exercise or training. I also acknowledge that the information provided in this questionnaire may be used by the medical and coaching staff to develop a personalized training plan for me.

Thanks for submitting!

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