Online Assessment

Name

First Name

Last Name

Age

Height

Weight

Emergency Contact

What are your overall health and fitness goals? (Be as quantitative and detailed as possible.)

What brought you to IronPlate?

Is taking measurements to track progress something you are interested in?

Have you had significant weight fluctuations in the past 10 years? If so, please explain.

What is your current training regimen?

How many days per week are you looking to come to IronPlate?

How many days per week do you have to commit to exercise and fitness?

Is nutrition education something you would like to incorporate into your program with us?

Yes

Not sure

If yes, please describe your current diet and lifestyle:

Do you have any food allergies?

Yes

Strong food dislikes?

Do you have any prior illnesses/injuries that we should know about?

Are you currently taking any medications that we should know about?

Do you have recent blood work you would like us to look at? Anything significant we should know (i.e. elevated blood pressure, elevated glucose, etc.)?

Is there anything else you feel we should know in order to get started together?

Thank you for contacting IronPlate. We look forward to working with you to achieve all of your goals!

The undersigned agrees and does hereby release from all liability and hold harmless IronPlate and any of its employees representing or related to the [Business]. This liability release is for any and all liability for personal injuries including death and property losses or damage in connection with any activity or accommodation of the above mentioned Business.

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