Contact Information

Full Name

Date of Birth

Gender

Phone Number

Email

Emergency Contact Name

Emergency Contact Phone

Primary Physician

Physician Phone

Health History

Please list any past or present conditions, injuries, medications, or relevant information:

Consent

By checking this box and submitting this form, you agree to the Coaching Agreement and Release of Liability, Code of Conduct, and Acknowledgement of Risks without a Medical Release Form provided by BodyFit LA, LLC. You acknowledge there may be service charge fees depending on the form of payment.

I agree to the terms and conditions stated above.

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