THE FITNESS GURU
PERSONAL STATISTICS
First Name:

Last Name:

Address: City: State:

Zip: Phone: E-mail:

Gender:

Age:

Weight (in pounds):

MEDICAL INFORMATION
Do you have heart disease, angina, or irregular heartbeats? Yes No

EXERCISE INFORMATION

Do you have access to... (Check all that apply:)
Gym or fitness center
Aerobics classes or video tapes
Treadmill