Crossover Fitness - Get Started w/ Fitness Assessment

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Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.
Area Code
Phone Number
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E-mail* This field is required.
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How can we help? Tell us why you're interested in working with a Crossover Fitness Coach.* This field is required.Please let us know if you were referred by a Crossover provider or program.
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Have you ever been diagnosed with (are you currently managing) any of the following chronic diseases, check all that apply?Fitness Safety Screen
Coronary Heart Disease
Coronary Artery Disease
High Blood Pressure
High Cholesterol
Autoimmune Disease
Type 2 Diabetes
Asthma
Sleep Disorder or Sleep Apnea
Depression or Anxiety
Obesity or Metabolic Syndrome
None of the above
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Informed Consent for Crossover Fitness* This field is required.I understand that the activities in this program may be strenuous, and may require me to do body movement that I may not be familiar with in order to improve overall fitness. I understand that I am responsible for monitoring my own condition throughout my workouts. Should any unusual symptoms occur, I will cease my participation and notify my healthcare provider. I know that there may be risks associated with the Fitness Program and willingly accept those possibilities. I know that it is my responsibility to ensure my own safety. I take full responsibility for my own health and safety in participating in the Fitness Program and to the extent I deem advisable, will consult a physician before participating in any of the activities. I freely and voluntarily agree to participate in the Fitness Program for my own personal benefit, and I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during the Fitness Program. I assume all risk for my health and well-being and hold harmless of any responsibility, the instructor, facility or any persons involved with the Fitness Program. I affirm that I have read, accept and understand this form in its entirety and that I understand the nature of exercise. Any cancellation or changes made less than 24 hours before your appointment time is considered a "late cancellation" and will result in a missed appointment fee equivalent to the session price (up to $85). Please cancel online, email fitness@crossoverhealth.com or call us at your earliest convenience to avoid a late cancel charge.
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Are you a Crossover Member?* This field is required.Crossover Members are eligible to receive one FREE Fitness Assessment ($85 value) per year. Crossover Fitness coaches will verify your eligibility for this benefit. If you qualify, they will provide you a coupon code to be used at the time of scheduling your assessment!
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