Worlds Best Trainer
1 Tuxedo Drive
Melville, NY 11747
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Bowflexercise & The Turning
Ordering Customized Workout, PleaseFill in as much as
Date of last physical
Resting Heart Rate:
What are your fitness goals?
Weight (muscle mass)
eating habits/overall health
Have you ever been in a
structured weight loss program ?
Do you smoke?
Has your doctor ever said you blood
pressure was too high/low?
Has your cholesterol level was to high?
Do you have any injuries or orthopaedic
Have you ever taken any prescribed
medications or dietary supplements?
Are you currently involved in a regular
Have you ever had or currently have
any of the following conditions. Check any that apply?
Bloating after meals
General Health & Nutrition
What type of supplements and how
are they delivered?
Do you have any other medical
Rate your health.
Rate your activity lavel at
How often do you currently exercise?
How long is each session?
Total hours a week?
Do you have any other medical condition
or problem not previously mentioned?
What are your goals with this program?
What have you eaten in the last three days.
*I acknowledge, to the best of my ability, that
I am in good health and have no known medical problems that
would restrict my ability to participate in this exercise
program. I am committed to making a positive change in my
health through my participation in the program. I understand
that certain aspects of this program can be physically
demanding. I also understand that I will need to change
various aspects of my life in order to obtain the goals I have
set forth. As a condition of my enrollment, I accept full and
complete responsibility for my own ability to healthful
participation in this program. This means I acknowledge that I
should obtain a physicians approval of my participation in
this program. I agree to hold George Baselice/Carmela Baselice
and the facility of World's Best Trainer/worldsbesttrainer.com
employees, shareholders, successors and assigns free from any
and all liability in connection with my performance or medical
conditions that might arise. I willingly and knowingly assume
for myself and my heirs executors, administrators and assigns
any risk which is associated with my participation in this or
any program related to World's Best Trainer/worldsbesttrainer.com