Fitness EMS Consent Form
Please complete the Fitness EMS Consent Form to participate in your electrical muscle stimulation session. This helps us ensure your safety and provide the best experience.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact Name
*
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you participated in EMS training before?
*
Yes
No
Do you have any of the following? (Check all that apply)
*
Pacemaker or implanted medical device
Pregnancy
Epilepsy
Recent surgery
None of the above
What are your fitness goals for EMS training?
Submit Consent
Should be Empty: