REGISTER

To register for Roadwork Fitness Online Training, complete the questionnaire and submit. We offer three different subscription options:

QUESTIONNAIRE

Visits:

Last name:	First name:	Email:
Age:	Gender:	Confirm email:
Weight:	Height: ft in

Medical history:
Asthma Cholesterol Diabetes Epilepsy		Heart High Blood Pressure Injury (list below) s Stroke
Other
Do you currently exercise:		Frequency (per week):
Please list current activities:		Where do you exercise: Home Gym Other
Example of a typical days diet:		List any food allergies:
What is your current goal:		Reasons for not reaching goal:
Program you would like created:		Equipment/weights you have at home: Free weights Machine Weights
How did you hear about Roadwork Fitness: