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Medical History

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I understand this information is to be used as a guide to provide me with a suitable exercise program based on my current medical condition. I understand that if medical clearance is required, I will consult my physician and obtain a clearance.

I agree to advise the trainer immediately there is any change in my medical condition or if I experience any discomfort while training.

I agree and accept that the Wellness Corporation or its officers or employees will not be liable for any personal injury or damage to my property while I am participating in any activity in the Wellness Corporation or any injury or damage resulting in any undisclosed medical conditions or issues.

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Start Goal Eval 1 Eval 2 Eval 3
Date
Height
Weight
Resting Heart Rate
Training Heart Rate
Skin fold measurement
Bicep
Skin fold measurement tricep
Skin fold measurement subscapular
Skin fold measurement supralliac
% body fat
% lean mass
Neck
Chest
Biceps (right/left)
Forearms
Waist
Hip
Upper thigh (right/left)
Calf

OFFICE USE ONLY