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DESTIN ALIEN

HEALTH ASSESSMENT PROTOCOL

GREETINGS EARTHLING - PLEASE COMPLETE YOUR CONFIDENTIAL TOPSECRET SCREENING BEFORE LAUNCH

Birthday
Month
Day
Year

Health Assessment

Welcome Earthling. Before Launch, Mission Control needs to confirm your body systems are cleared for safe training.

All health and readiness information provided in this form is confidential and used solely to ensure safe and appropriate training.

Your information will not be shared, sold or disclosed to any third party without your consent, except as required by law.

Check box(es) next to any condition that currently applies to you or has applied to you in the past.

Section 1 : Cardiovascular & Metabolic Health

Check all that apply

Section 2 : Orthopedic & Musculoskeletal Status

Check all that apply

Section 3 : Neurological & Consciousness

Check all that apply

Section 4 : Respiratory & Immune

Check all that apply

Section 4 : Medications & Substances
Section 5 : Mental & Stress Load

Check all that apply

Section 6 : Performance & Recovery Readiness
Sedentary
Light Activity
Moderate training
Advanced Athlete
Section 7 : Average Sleep per Night
<5 hrs
5-6 hrs
6-7 hrs
7+ hrs

Section 8: Mission Review & Training Clearance Check

Certain responses may require additional review or program adjustments prior to high- intensity training.

Has a licensed healthcare provider ever advised you to limit or avoid certain types of physical activity?
Have you experienced chest pain, dizziness, or shortness of breath at rest or during physical exertion in the past 6 months?
Have you been hospitalized, underone a medical procedure or experienced a significant injury in the past 6 months?
Have you ever lost consciousness or felt close to fainting during physical activity?
Do you currently have any condition that could be worsened by moderate or high-intensity exercise?

A "YES" response to any question in this section will require a written medical clearance before participation in certain training activities.

Section 9 : Acknowledgement & Clearance

Do you understand that participation in physical training involves inherent risks, including injury, and that not all risks can be eliminated?
Do you agree to immediately inform your trainer of any pain, discomfort, dizziness, or unusual symptoms during training?
Do you understand that exercise modifications or limitations may be required based on your health responses.
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