Yes! Please enroll me in the Fizikaflex Community

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any vigorous physical activity. I agree to assume full responsibility for any risks, injuries known or unknown which I might incur as a result of participating in the program.

I knowingly, voluntarily and expressly waive any claim I may have against Fizika Group, LLC or Fizikaflex for injury or damages that I may sustain as a result of participating in the program.

I agree to allow any photos, videos or feedback I provide regarding Fizikaflex to be shared privately and publicly by Fizika Group, LLC

I have read the above waiver and release of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

First Name

Last Name

Date of Birth

Are you?

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FemaleFemale

Phone

Yes, I would like to opt into Fizikaflex text message reminders.

Preferred Language?

EnglishEng
EspañolEsp

Would you like to authorize an additional user to access your Fizikaflex account?Yes

Fizikaflex Physical Activity Readiness Questionnaire

Please review each question and check where applicable.

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Do you feel pain in your chest when you perform physical activity?

In the past month, have you had chest pain when you were not performing any physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Is your doctor currently prescribing any medication for your blood pressure or a heart condition?

Do you know of any other reason why you should not engage in physical activity?

Fizikaflex connects with any internet enabled device. Which of the following options best describe you? Select all that apply.I have a smart phone.I have access to an internet enabled device where I can enter data into Fizikaflex

Do you have a device to track your steps (i.e., Fitbit)?Yes

Do you participate in Silver Sneakers?Yes

Do you live in a retirement community?Yes

Do you have condition(s) that you'd like to manage using Fizikaflex?Yes

Do you have health insurance?Yes

Invitation Code

Acceptance of Terms

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To accept the terms of this agreement, please enter your full name in the box above and click submit