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Silver Lake Fitness Questionnaire

Columbia Athletic Club > Silver Lake Fitness Questionnaire

Silver Lake Fitness Questionnaire

Phone

This field is for validation purposes and should be left unchanged.

First Name(Required)

Last Name(Required)

Date of Birth/Age(Required)

Today's Date(Required)

Preferred Email Address(Required)

Preferred Phone Number(Required)

Fitness Goals (click all that apply)(Required)

Weight loss

Muscular Development

Cardiovascular Fitness

Improved Athleticism

Improved Body Composition

Improve Strength

Improved Range of Motion

Improved Nutritional Lifestyle

Injury Reduction/Post Physical Therapy Training

General Health and Wellness

Fitness Education

Consistency

Other (please specify)

Other

How many times a week do you work out?(Required)

Please enter a number from 1 to 20.

What currently may be a barrier to reaching these goals (click all that apply)(Required)

Lack of Time

Work Hours

Transportation

Current/past injury

Finances

Lack of Motivation/Accountability

Knowledge/Intimidation

Other (please specify)

Other

6. What CAC training solution(s) most interest you (click all that apply)(Required)

The 4-step Training Process

Strategy Session

21-Day Jump-Start Challenge

1:1 Personal Training

1:1 S.C.O.R.E Training

IMPACT small group personal training

Summer S.C.O.R.E Athlete Development Program

Something other than what is listed (please specify)

Other Training Solution

Anything else you would like us to know?

This portion of the Questionnaire is designed to identify the small percentage of adults who should obtain medical clearance before beginning an exercise program.

1. Has your doctor ever said that you have a heart condition and should only do physical activity recommended by a doctor?(Required)

Yes

No

2. Do you feel pain in your chest when you do physical activity?(Required)

Yes

No

3. In the past month, have you had chest pain when you were not doing physical activity?(Required)

Yes

No

4. Do you lose your balance because of dizziness or do you ever lose consciousness?(Required)

Yes

No

5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?(Required)

Yes

No

6. Is your doctor currently prescribing drugs for your blood pressure or heart condition?(Required)

Yes

No

7. Do you know of any reason why you should not do physical activity?(Required)

Yes

No

Included with your membership is a FREE hour with a Personal Trainer. You will be contacted shortly after this form is submitted.

INSPIRING HEALTHIER LIVES SINCE 1981

Juanita Bay

425.821.0882

MON – FRI

5am – 10:30pm

SAT & SUN

6am – 8pm

Pine Lake

425.313.0123

MON – FRI

5am – 10:30pm

SAT & SUN

6:30am – 10:30pm

Silver Lake

425.745.1617

MON – FRI

5am – 10pm

SATURDAY

7am – 10pm

SUNDAY

7am – 8:30pm

Super Range

425.338.2424

Mon - Sun

9am - 10pm

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