Client Info/Medical Sheet

Please fill this out before your first session. It goes straight to Coach Dave.

Client Information

Name Date Street Address City State Zip Code Phone E-Mail Emergency Contact Phone Age D.O.B. Height Weight

Current Medical Conditions? Y N

If yes,

Medications? Y N

If yes,

Past Injuries/Surgeries? Y N

If yes,

Limitations? Y N

If yes,

Other:

Other:

If you have a medical condition, attach a note from your doctor (photo or PDF).

Fields marked * are required. Your answers go privately to Shaka Strength Fitness.