Initial Questionnaire

Name (required) Surname (required)

Addres (required) City (required)

e-mail (required) Telephone (required)

Born Date (required)

Occupation

1 - Have you ever suffered from any of the folowing? (required)
NoneAsthmaArthritisOsteoporosisCholesterolHypertensionAnorexyHerniated DiscEpilepsiaHyperthyroidismHypothyroidismChest PainHeart or Pulmonary DiseaseDizziness or FaintingBack, Lumbar or Cervical PainOther
(if you have checked another, indicate which)

2 - Are you taking any medication? (required) SINO
(If yes, please indicate which)

3 - Are you recovering from a recent operation? (required) SINO
(If yes, please indicate which)

4 - ¿Are you pregnant? (required) SINO

5 - ¿Do you smoke? (obligatorio) SINO

6 - Do you actually do physical exercise regularly? (required) SINO

7 – What exercise programms have you followed previusly? (required)
DanceSwimmingJoggingGymOther

8 - What are your goals? (required)
WeightlossImprove your HealthIncrease of Muscle MassRehabilitation of an injuryMaintenancePhysical Fitness Training

9- Where did you hear about Gym Studio 1?

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