All information provided in this form will be kept strictly confidential and is submitted via a secure webpage.
This form will take between 10-20 minutes to fill out, depending on how much detail you put into the answers.
You will need a tape measure to measure hips and waist. Also, I will ask you for your resting heart rate. If you do not have time today to answer those questions, skip them for now. To measure resting heart rate, take pulse upon waking up (before sitting up or standing up). The alternative method is to lie down for 10 minutes and then take pulse.