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To help tailor a beneficial program, and avoid injury to our Members, we need to ask a few questions about your health.    This information is a requirement for all of our classes, but rest assured this information is  **NOT SHARED OR DISCLOSED**  as outlined in our Privacy Policy.

Health History

Please fill out the following form to help us understand your physical condition.

Examples of Medical Conditions we would need to know about:

  • Discomfort in Upper/Middle/Lower back

  • Discomfort in Shoulders

  • Knee/Hip/Pelvis pain or Discomfort

  • Head/Neck Pain or Discomfort

  • Arthritis

  • Herniated Disc

  • Joint Replacement

  • Neurological Conditions (MS, Parkinson's, etc..)

  • Osteopenia/Osteoporosis

  • Pregnancy

  • Stroke

  • Surgery within the last 3 months

Are you currently suffering from a medical condition, illness, or injury?
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