W Athletic Club - Join Today

Ready to get started?

How did you hear about Wimberley Athletic Club?
If referred by a friend please enter their name below, or else enter N/A: (required)
If referred by a Physician please enter their name below, or else enter N/A: (required)
Drove By
Outdoor Signage
Television
Radio
Direct Mail
Phone Book
W Athletic Club Newsletter
Other:

Tell us about yourself:
Name:	(required)
Occupation:
Age Range:
Date of Birth:
Phone (W):
Phone (H):	(required)
Address:	(required)
City:	(required)
State:	(required)
Zip:	(required)
Primary E-mail:	(required)
Secondary E-mail:	(required, please enter primary e-mail if no secondary e-mail is available)

Lifestyle/Daily Activity Routine: (Describe a typical day from waking to sleep)

Activity History: (Have you ever exercised before? If yes, what type and how often?)

Injuries or Health Concerns:
Spinal Stabilization	Disc Herniation
Post Partum	Rotator Cuff Tear
Hypertension Exercise	Impingement Syndrome
Post Surgical: Knee/Back/Shoulder	Cervical Spine
ACL Rupture/Reconstruction	Lower Back Pain
Total Knee Replacement	Diabetes
Degenerative Joint Disease	Functional Training
Total Hip Replacement	Patello-femoral Syndrome
Spinal Stenosis	Meniscal Tear
Please give us more details on any box checked:

Do you have any reason to believe you should not exercise?

Desired Changes/Goals:
Professional Resistance/Strength Training	Yoga Classes - Individual Sessions & Classes
Sports-Specific Performance Enhancement	Medical Exercise for Disease Management
Cardiovascular Training	Senior Conditioning
Professional Fitness Training	Cardiac Rehabilitation
Running Improvement	Physical Therapy
Cycling Improvement	Post Surgical Rehabilitation
Aerobics Classes	Post Rehab - Total Knee Replacement
Swim Training	ACL and Meniscus
Weight Reduction	Rotator Cuff Repair
Flexibility Training	Balance/Coordination/Proprioception
Sports Injury Prevention	Pilates
Other (please explain below)
Goals/Changes:

Long Term Goals (6-12 months):

Short Term Goals (0-6 months):

Additional Comments:

W Athletic Club
600 Ranch Road 3237
Wimberley, Texas 78676
512.847.0353
E - mail: Strength@WAthleticClub.com
Click here for a map to the club.