Fill out your medical history form, download agreement of release of liability and/or medical clearance forms. All new clients will need to fill out and sign the medical history form AND the release of liability before initial assessment. Don't hesitate to CONTACT SOLFIT if you have any questions. 

Medical History Form I: General

Name *
Name
Address *
Address
Phone *
Phone
Today's Date *
Today's Date
Date of Birth *
Date of Birth
Please list all known medical conditions. If you have received a diagnosis from a medical professional, note below. If you do not have any medical conditions, please write 'none' below
Claim Adjuster Phone
Claim Adjuster Phone
Has your doctor said you have any cardiovascular problems? *
Do you frequently suffer from chest pains? *
Have you ever had a heart attack? *
Do you ever experience an irregular or racing heart rate during exercise OR at rest? *
Has your doctor ever said that your blood pressure is high? *
Do you often have difficulty breathing OR suffer from any respiratory conditions? *
Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise? *
Is there a good physical reason not mentioned in this form why you should not follow an activity program even if you wanted to? *
Are you over the age of 65 and not accustomed to vigorous exercise? *
Are you diabetic? *
Are you pregnant? *
Have you ever received physical therapy or chiropractic care? *
Have you ever received physical therapy or chiropractic care?
Have you or any members of your immediate family been diagnosed with any of the following conditions: *
Have you or any members of your immediate family been diagnosed with any of the following conditions:
How many hours a week do you work: *
0 1-20 20-30 30-40 >40
How do you spend most of your time at work:
Do you smoke? *
How many times per week do you engage in moderate or strenuous activity for at least 30 minutes: *
Do you have any pain when exercising: *
Please rate your pain on a 1-10 subjective scale. If you do not experience pain during exercise, check '0'. Please check only one box.
Electronic Signature Agreement
By selecting the "I Accept" button, you are signing this medical history form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you legally consent that all information provided on this form is true and accurate to the best of your knowledge. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide SolFit instructions via the SolFit website (www.solfit.org), or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and SolFit. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement.
Please sign by writing your first name, last name and today's date

Download and sign the Solfit Exercise Services Training Agreement

Click here to download and sign your Exercise Services Training Agreement. It will be collected at your initial consultation or assessment.


Download Medical Release

If deemed necessary, you may need to get a signed medical release from your physician, physical therapist or operating surgeon before initial assessment. Click Here to Download the Medical Release Form. The form can usually be faxed or dropped off at the medical professional's location of practice. The form can then either be picked up at that location or it may be returned to you via fax.