Thank you for your interest in Thrive Personal Fitness!

In order to best meet your needs and provide you the best possible exercise prescription, we ask that you please fill out the following questionnaire. This information is completely confidential and is required to make an initial assessment of how to safely proceed with your program. Once the questionnaire is complete and submitted, you will be contacted within 24-48 hours. The initial consultation is free and you are under no obligation. Should you have any questions please use the email form, or feel free to give us a call at (417) 766-6612.

Preparticipation Screening Page 1

1. Your Name(required)
2. Email(valid email required)
3. Street Address(required)
4. City(required)
5. State -- Alabama (AL) Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) District of Columbia (DC) Florida (FL) Georgia (GA) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Puerto Rico (PR) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virgin Islands (VI) Virginia (VA) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY) (required)
6. Zip Code(required)
7. Phone Number(required)
8. Preferred Method of Contact -- Email Phone (required)
9. Best Time to Contact(required)
10. Sex -- Female Male (required)
11. Age(required)
12. Height (in inches)(required)
13. Current Weight (in lbs)(required)
14. Current Body Fat %(required)
15. Desired Weight (in lbs)(required)
16. Type of training you are interested in -- Personal Fitness Coaching Personal Training Springfield, MO Personal Training Nixa, MO (required)
17. How did you hear about us(required)
18. Online Code