Groupon customers

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Personal Information

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Package

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PAR Q

Do you frequently have pains in your chest when you perform physical activity?
In the past three months, have you had chest pains when doing physical activity?
Has your doctor ever recommended starting a physical exercise program?
Do you lose balance due to dizziness, or do you ever lose consciousness?
Do you have bowel, joint or other health problems that must be addressed when developing an exercise program?
Are you pregnant now, or have you given birth within the last 6 months?
Have you had surgery within the last 6 months?
If yes to any questions, please describe:

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Waiver


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