X3 Performance and Physical Therapy
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Personal Training Questionnaire

Main Reason For Wanting A Free Initial Fitness Assessment *(Required)
Main Reason For Wanting A Free Initial Fitness Assessment *

Do you smoke or use a vaporizer alternative?(Required)
Do you smoke or use a vaporizer alternative?
Do you drink alcohol?(Required)
Do you drink alcohol?
Describe your job:(Required)
Describe your job:
Is anyone in your family overweight?(Required)
Is anyone in your family overweight?
Were you overweight as a child?(Required)
Were you overweight as a child?

Does your occupation require extended periods of sitting?(Required)
Does your occupation require extended periods of sitting?
Does your occupation require repetitive movements?(Required)
Does your occupation require repetitive movements?
Does your occupation require you to wear shoes with a heel (e.g., dress shoes, work boots)?(Required)
Does your occupation require you to wear shoes with a heel (e.g., dress shoes, work boots)?

Do you partake in any recreational physical activities (golf, skiing, etc.)?(Required)
Do you partake in any recreational physical activities (golf, skiing, etc.)?
Have you been exercising consistently for the past 3 months?(Required)
Have you been exercising consistently for the past 3 months?

So that we can schedule your Free Fitness Assessment as soon as possible, please provide us with:

Name(Required)
Consent(Required)
X3 Performance and Physical Therapy

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  • May 2022

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  • Ft. Myers
    • 239-313-6109
    • kelly@x3ppt.com
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    • 615-988-4550
    • sarah@x3ppt.com

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