This is a screening tool to determine if you're ready to begin the Body Genie program. Please answer Yes or No to each of the following questions.

1. Have you ever been medically diagnosed with high cholesterol/triglycerides or are currently taking medication for blood lipid levels?
2. Have you ever been medically diagnosed with hypertension or are currently taking medication for high blood pressure?
3. Have you or your parents or siblings had a history of heart attack, blocked coronary arteries, heart surgery, or other heart conditions before the age of 60?
4. Do you now or have you ever smoked cigarettes or used any other tobacco products on a regular basis?
5. Is your lifestyle sedentary with very little or no physical activity?
6. Have you ever been medically diagnosed with or are currently taking medications for diabetes?
7. Have you ever been medically diagnosed with or are taking medications for asthma?
8. Do you have mitral valve prolapse and take medications before dental procedures?
9. Have you experienced dizziness or light-headedness that has resulted in a fall or loss of consciousness?
10. Are you currently pregnant or have you given birth within the last eight weeks?
11. Do you experience heart pain or sensations of pain, burning, discomfort, or tightness in your chest radiating into your arm, jaw, neck, or back?
12. Do you have a history of stroke, peripheral vascular disease, claudicating, or recurrent bilateral ankle swelling?
13. Do you frequently experience heart palpitations, skipped heart beats, or out of control heart rhythms?
14. Do you have chronic lung disease or unusual shortness of breath with normal activities?
15. Are you allergic to certain types of food?
16. Through your own experience or by a physician's recommendation, are you aware of any reason to have supervision present when you exercise or to restrict your exercise activity?
17. Have you been recently hospitalized for injury or illness causing you to miss work or limit your activity?
18. Do you have any medical concerns, limitations, or situations that should be addressed by a physician before participating in any nutritional or exercise related program?

Body Genie requires that you consult with your physician before following any training instructions you receive through the Application or participating in any event announced through the Application. Body Genie is not a licensed medical care provider and represents that it has no expertise in diagnosing, examining, or treating medical conditions of any kind, or in determining the effect of any specific diet or exercise on a medical condition. The Application is not a prescription system and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should understand that when participating in any diet or exercise program, you do so at your own risk. If you should ever feel discomfort or pain, do not continue.

You should never disregard medical advice or delay in seeking it because of something you see or read in the Application. We are not responsible for any health problems that may result from training programs, products, or events you learn about through the Application. If you engage in any diet or exercise program you receive through the Application, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and discharge Body Genie from any and all claims or causes of action, known or unknown that may arise. You agree to indemnify and hold harmless Body Genie for any loss, liability, claim, damage, and expenses (including attorneys' fees) arising from or in connection with your use of the information or services you receive through the Application.

CAUTION: It is STRONGLY recommended that you see a physician for a complete medical examination before undertaking any nutritional or exercise program. Particularly if you have a family history of high blood pressure or heart disease, are over the age of 45, smoke, have high cholesterol, suffer from obesity, or have not exercised regularly in the past year. If at any time while exercising, you experience faintness, dizziness, pain or shortness of breath you should stop immediately and consult your physician.

In order to complete this membership registration, you must be able to answer No to every question on the Health History Questionnaire. If you cannot truthfully answer No to every question, we cannot provide you with nutritional and exercise related information contained in the Application.

I accept the terms of the User Agreement above, and I have answered the Health History Questionnaire truthfully and to the best of my knowledge.