Submit by Email Print Form WELLNESS ENRICHMENT SUITE MEDICAL HISTORY FORM Name (First and Last): D 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your full name in the designated field labeled 'Name (First and Last)'.
3. Fill in your date of birth (D.O.B), email address, and preferred phone number to ensure accurate contact information.
4. Select your gender from the options provided.
5. Indicate which service you are registering for by checking one of the options listed, such as 'LIFE Senior Fitness Program' or 'Personal Training'.
6. Assess your health by marking all true statements regarding past medical history and current health conditions.
7. List any medications, physical limitations, or recent surgeries that may affect your participation in the program.
8. Review the waiver and signatures section carefully before signing to confirm that all information is accurate.

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