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Pre-Assessment Form

Northeast Ohio Certified Personal Trainers

Pre-Assessment Formvirteom2024-01-08T10:55:21-04:00

Ready to Strengthen Your Life?

We are ready to help.

Please fill out the pre-assessment form below for your FREE Fitness Assessment and Workout. It will take approximately two minutes to complete.

Your FREE Fitness Assessment and Personal Training Workout includes:

1 hour session with certified Prescription Fitness trainer at one of our 7 locations: Bay Village, Broadview Heights Rec., North Olmsted Rec., Medina Rec., Westlake Rec., Macedonia Rec., or Reminderville Athletic Club
Review of your health and exercise history
Discuss goals for your health and life
Body composition measurements and stats
Foundations workout to see where your fitness level is at and what you can do

At the end of your session, you will have a better understanding of your current fitness level, goals for your future self and professional guidance on how to achieve those goals.

We are excited to help you strengthen your life! Fill out the form below.

Ready to Strengthen Your Life?

We are ready to help.

Please fill out the pre-assessment form below for your FREE Fitness Assessment and Workout. It will only take two minutes to complete.

FREE Fitness Assessment and Workout includes:

1 hour session with certified Prescription Fitness trainer
Review of your health and exercise history
Discuss health and life goals
Body composition measurements and stats
A foundations workout

We are excited to help you strengthen your life! Fill out the form below.

Pre-Assessment Form

Step 1 of 4

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Name(Required)

First Last

Email(Required)

Phone(Required)

How did you hear about us?(Required)

Which location would you want to workout at?(Required)

By submitting this form, you consent to receive SMS messages from Prescription Fitness.(Required)

I consent to receive SMS messages from Prescription Fitness

Reply "STOP" to unsubscribe. Standard message and data rates may apply. Your information will be handled in accordance with our Privacy Policy.

Address

Street Address Address Line 2 City State ZIP Code

Date of Birth

MM slash DD slash YYYY

Height

Weight

Emergency Contact Name

First Last

Emergency Contact Phone Number

Describe any physical activity you do somewhat regularly:

History of heart problems, chest pain, high bp, or stroke?

Yes

Any chronic illness or condition?

Yes

Any recent surgeries? (12 months)

Yes

Pregnancy? (now or within the last 3 months)

Yes

Muscle, joint or back disorder or previous injury still affecting you?

Yes

Hernia of any condition aggravated by lifting weights?

Yes

List any other medical conditions or information not listed above

Were you a high-school athlete?

Yes

If so, please specify

Do you have any negative feeling towards, or have had any bad experience with a physical activity program?

Yes

If so, please specify

Do you start exercise programs but then find yourself unable to stick with them?

Yes

If so, please specify

How many days a week are you willing to devote to an exercise program?

Please enter a number from 1 to 7.

What days and times fit your schedule best for training?

What types of exercise interest you? Check all that apply

Walking

Biking

Swimming

Eliptical

Strength Training

Mobility/Flexibility

List your top 3 health and fitness goals...

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Name

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Strengthen your life with the certified Northeast Ohio personal trainers at Prescription Fitness. We are committed to delivering personalized, premium fitness programs with a professional, supportive team network that nurtures long-lasting, positive lifestyle changes.

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LOCATIONS

Bay Village
27101 Knickerbocker Rd. Bay Village, Ohio 44140

Broadview Heights Rec Center
9543 Broadview Road, Broadview Heights, OH

North Olmsted Rec Center
26000 Lorain Road, North Olmsted, OH 44070
Medina Rec Center
855 Weymouth Rd, Medina, OH 44256

Westlake Rec Center
28955 Hilliard Blvd, Westlake, OH 44145

Macedonia Rec Center
1494 East Aurora Rd., Macedonia, OH 44056

Reminderville Athletic Club
3100 Glenwood Blvd., Reminderville, OH 44202