Health Assessment | G3 CorePower

Please fill out the following form completely. Your coach will use this baseline information when designing your training program.

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Have you been hospitalized in the last 12 months?

No

Yes

Are you suffering from a medical condition, illness, or injury?

No

Yes

If you answered yes to either question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

PART II

Please fill out the following form completely. Your coach will use this baseline information when designing your training program.