1 on 1 personal training inquirY Name * First Name Last Name Email * Age * MM DD YYYY Do you have any known medical conditions? Currently taking any medications? Family history of heart disease, diabetes, other chronic conditions? How would you rate your fitness level? (Poor/Fair/Good/Excellent) Do you currently exercise? (if yes, please describe routine) Have you ever worked with a personal trainer? Yes No If yes, why did you stop? Thank you!