As a new member you will receive a Comprehensive
Fit/Rehab Evaluation by our Specialists Call
703-444-4446
Essential
Downloads for becoming a member of the RxFitness Women's Circuit Club
Step #1
All new members need to fill out the following forms before you
come: Open the form, print it out on your computer, Fill the form
out completely, bring it with you.
C-01 Exercise Readiness
C-02 Consent To
Participate Form
C-03
Medical Clearance Form
Step #2. If you have pain anywhere, please
fill out the next forms.
You should have just completed step #1
Now click on the following areas of the body and fill out the
appropriate questionnaire form if applicable to your area of
concern.
Note:
Please select what is applicable to you. Ex. If you have neck pain,
only fill out C-04. If you have back pain, fill out C-05. If you
have more than one condition, fill out the appropriate form for your
condition
C-04
Neck
Questionnaire
C-05 Lower Back Questionnaire
C-06 Knee Questionnaire
C-07 Shoulder Questionnaire
C-09 Headache Questionnaire
C-10 Arm, Elbow, Wrist, Hand Questionnaire
If you need to lose weight or have a
nutritional problem proceed to step Step #3 Nutrition
Food Journal fill out for 2-4 typical days.
A few regular week days and weekends are fine. Every thing you eat
and the amount needs to be recorded. For example if you had
French fries please include if they were baked or from fast food,
the size of the order, and if you used ketchup with the fries.
n-01 Food Journal
Next is a detailed symptom survey specific for nutritional
deficiencies. Mark the box with a 1 if you experience that
symptom a few times per year. Mark a 2 if you experience that
symptoms a few times per month. Mark a 3 if you experience
that symptom a few times per week.
n-1 Nutrition Questionnaire
n-2 Nutrition Questionnaire
n-3 Nutrition Questionnaire
n-4 Nutrition Questionnaire
Please bring these forms with you.
To find more information about our amazing sister company NOVA
Rehabilitation please visit
www.novachiro.com
