Name *
Name
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *
Please Check Yes or No for the next 12 Questions
Do you feel pain in your chest when you perform physical activity? *
In the past month have you had chest pain when you were not performing physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *
Do you know of any other reason why you should not engage in physical activity? *
Have you ever had any joint injuries? *
If you have answered yes to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered yes to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.
Have you ever had surgeries? *
Has a medical doctor ever diagnosed you with a chronic disease? *
Are you currently taking any medication? *
Do you have a hernia, or had a hernia in the past? *
Release Of Liability
At MSC we do not do per session billing. We run on monthly billing cycles across all spectrum's of service products. (Example: Unlimited S&C at 120$ per month.) You must satisfy the service due on a monthly basis and must give 30 days notice if you with to cancel with the service or service provider. So, if it's June 25th and you want to cancel for July, It's to late, you will be billed for July and your draw will terminate after that.)
I Have Read and Understand The Release of Liability
Date *
Date
Name of Minor is signing for Minor
Name of Minor is signing for Minor
Name of Minor If signing for Minor
Name of Minor If signing for Minor
Signature *
Signature
This is my Electronic Signature and I have not made any false claims.