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Beach Fitness


Contact Information


Additional Information

Gender


GOALS

Health & Fitness

Strength/Endurance

Special Event Preparation

Weight Loss/Management

Rehabilitation/injury


Hear About Us

How did you hear about us?


HEALTH HISTORY

1. Are you currently being treated for any other medical condition by a physician?

2. Have you been told by a health professional that you should not exercise?

3. Have you ever had a definite or suspected heart attack or stroke?

4. Have you ever had a coronary bypass surgery or any other type of heart surgery?

5. Do you have any other cardiovascular or pulmonary (lung) disease?

6. Are you currently under treatment for any blood clots?

7. Have you ever had a history of diabetes, thyroid, kidney, or liver disease?

8. Within the past 12 months has a health professional told you that your blood cholesterol or lipids profile was abnormal?

9. Do you currently have High Blood Pressure or has a health professional ever told you that you have High Blood Pressure?

10. Currently, or within the past 12 months have you taken any medicines to control your blood pressure?

11. Do you currently have any of the following symptoms?

a. Pain/discomfort in the chest (area) when you engage in physical activity?

b. Shortness of breath

c. Unexplained dizziness or fainting

d. Swelling of the ankles (recurrent and unrelated to injury)

e. Heart palpitations (irregularity of heart beat on more than one occasion

f. Known heart murmur

12. Do you currently smoke cigarettes or have you quit in the previous 12 months?

13. Any problems with bones, joints, or muscles that may be aggravated with exercise?

14. Have you had any broken bones?

15. Do you have any neck and/or back problems?

16. Have you had surgery and/or been diagnosed with any disease?

17. Are there any other conditions (Mitral Valve Prolapse, Epilepsy, history of Rheumatic Fever, Asthma, Cancer, Anemia, Hepatitis, etc.) that may hinder your ability to exercise?

For Women Only

18. Are you pregnant or is it likely that you could be pregnant at this time?

19. Are you taking hormone replacement?

20. Have you ever had any breast surgeries, reductions, biopsies, or augmentations (reconstruction or cosmetic)?

Please list below all prescription and over-the-counter medications you are currently taking:
I have answered the Health History Questionnaire accurately and completely. I understand that my medical history is a very important factor in the development of my fitness/wellness program. I understand that certain medical or physical conditions which are known to me, but which I do not disclose to Beach Fitness, Inc. may result in serious injury to me. If any of the above conditions change, I will immediately inform Beach Fitness, Inc. of those changes. I knowingly and willingly, assume all risks of injury resulting from my failure to disclose accurate, complete, and updated information in accordance with the attached questionnaire.

February 17, 2020


Private Training Client Information

I understand that I am responsible for:

✓ Providing accurate information about your present, past and future health history.

✓ Asking questions if you do not understand the explanation of your analysis, fitness programs, or any instructions.

✓ Providing the necessary and accurate personal information.

✓ Updating Beach Fitness about any changes or updates in your health and fitness status.

✓ Following rules and regulations given by or posted within Beach Fitness Inc.

✓ I have read and received a copy, understand, and agree to all the Beach Fitness Policies and Procedures on the following page.

✓ I have read and received a copy, understand, and agree to the Beach Fitness Informed Consent of Training Program on the following page.

BEACH FITNESS POLICY

Sessions Purchased – We have a no refund policy on sessions purchased. If there is some reason that you are unable to continue your exercise program please contact us ASAP at [email protected] or call 562.493.8426.
You may access your statement or a receipt of sessions used at any time by logging onto beachfitness.com and clicking the link and setting up your account. Near the end of each package you will be invoiced based on the last package purchased.

Cancellation & Rescheduling Policy – In order to accommodate your scheduling needs your trainer may be substituted without prior notice. Beach Fitness will make the best attempt to notify you in advance of any scheduling changes.

24-hours advance notice is required for cancellation or rescheduling of all appointments. Failure to cancel within this time frame or failure to show up for a session will result in the full charge for the session. Exceptions will only be made in the case of a medical emergency accompanied by a doctor’s note. Please call or email us at [email protected] of you have any concerns or questions.
Tardy Policy – Clients are expected to begin working out at the start time of the scheduled appointment. A late start time does not entitle a client to a session longer than the scheduled appointment. A late start time does not entitle a client to a session longer than the scheduled appointment. If a client is more than 10 minutes late without prior notice it will be considered a no show or missed appointment and the client will be charge full rate for the session.

INFORMED CONSENT OF TRAINING PROGRAM

Description of Potential Risks - I understand that no exercise program is without inherent risks regardless of the care taken by a personal trainer and that my personal safety cannot by guaranteed by my personal trainer. I realize that when participating in any exercises, particularly those that induce cardiovascular stress, there is chance of serious injury (e.g. heart attack, stroke, or other cardiovascular accidents) or catastrophic incident (e.g., death, paralysis). Likewise, I know that engaging in muscular endurance, strength building, and other fitness activities sometimes results in minor injuries (e.g.; bruises, musculoskeletal strains and sprains), less frequently, more serious injuries (e.g., muscle tears, herniated disks, torn rotator cuffs) and rarely, catastrophic injury (e.g., death, paralysis).

Participant Responsibilities – I understand that it is my responsibility to 1) fully disclose any health issues or medications that are relevant to participation in a strenuous exercise program; 2) cease exercise and report promptly any unusual feelings (e.g. chest discomfort, nausea, difficulty breathing, apparent injury) during the exercise program; and 3) clear my participation with my physician.

Participant Acknowledgements – Agreeing to this exercise program I acknowledge that my participation is completely voluntary. I understand the potential physical risks involved in the exercise program and believe that the potential benefits outweigh those risks. I give consent to certain physical touching that may be necessary to ensure proper technique and body alignment. I understand that the achievement of your health or fitness goals cannot be guaranteed. I have had a voice in planning and approving the activities selected for my exercise program. I have been able to ask questions regarding any concerns I might have, and have had those questions answered to my satisfaction. I am in good physical condition, have no impairment, which might prevent my participation in such activities, and have been advised to consult a physician prior to beginning this program. I have been advised to cease exercise immediately if I experience unusual discomfort and feel the need to stop.

I have read and understand the above agreement; I have been able to ask questions regarding any concerns I might have; I have had those questions answered to my satisfaction; and I am freely signing this agreement.

February 17, 2020


Credit Card Information


Beach Fitness Credit Card Authorization

Client confidentiality is of utmost concern for Beach Fitness and its clients. Beach Fitness Inc. does not share any credit information, run credit checks, or report to any credit agencies. Your security is our concern and we do everything possible to protect your credit information.

By signing the Beach Fitness Credit Card Authorization I agree to allow Beach Fitness Inc. may hold my credit card information on file and give Beach Fitness the right to charge my card to purchase or renew my training package and/or products or services that I mutually agree to purchase. I also understand that all sales are final and once my card is charged there are no refunds for any products or services purchased.

February 17, 2020