CFIF

CF:IF Medical Evaluation Form
Name *

First Name Last Name
E-mail *

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Question 1
Do you currently exercise? *

YES NO
Over the last month, how many times a week have you exercised?
On average how long do these sessions last?
Average minutes per session
Physical Activity Vital Sign

Question 4
Has a doctor ever told you not to participate in vigorous physical activity? *

YES NO
why?

Question 5
Do you have any muscular or skeletal issues that limit or restrict your participation in physical activity? *

YES NO
What?

Question 6
Do you have any other reason that you think should restrict your participation in physical activity? *

YES NO
What?

CF:IF Medical Evaluation Form
Congrats!! you are fit to start unrestricted participation at IslandFit.
Someone will be contacting you soon to discuss the need for you to get medical clearance
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