Close icon
 
Close popup
Have an account?
New customer?
First Name
Last Name
Email address *
Password *
Re-enter password *
Cell Phone
Home Phone
Work Phone
Ext
Date of Birth
Gender
Address
City
Postal\Zip Code
Home location
Referred by:
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem (for example; back, knee, or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?