Yes_________________________________ No High blood pressure / Allergies / No Hernia / No Diabetes / stroke / No Obesity / Yes_________________________________ No Other chronic illness / Yes_________________________________ No Prior injury / Thyroid Disorder / Yes_________________________________ No Chest pain / asthma / /
Lewis & Clark Orthopedic & Sports Therapy Lewis & Clark Athletic Circuit Training Program 2525 Fox Run Pkwy, Suite 100, Yankton, SD 57078 • PHONE[removed] • FAX[removed]Registration, Health History, and Cons