Membership Introduction Form Contact InformationFirst Name *Last Name *Email Address *Phone *About YouAge *0 / 2Are You a Veteran? *YesNoWhat is your reason or goal for joining The Turn? *Health ConditionsPrimary Health Condition *Date of Diagnosis *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212521242123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925An exact date is not required. Please estimate as best you can.Additional Health ConditionsGeneral Health QuestionsHave you experienced shortness of breath, chest discomfort or pain, rapid heartbeat with physical activity? *YesNoHave you experienced any joint, bone, or muscle pain in the last 6 months? *YesNoHave you experience any dizziness or loss of balance in the 12 months? *YesNoHave you been hospitalized in the last 12 months? *YesNoHave you had recent surgery? *YesNoAre you currently in physical therapy? *YesNoDo you use an assistive device or wheelchair? *YesNoDo you know of any other reason why you should not do physical activity? *YesNoAdditional InformationAdd any comments or information you wish to share with The TurnSUBMIT MEMBER INTRODUCTION FORM If you are unable to complete this form online, you may call The Turn to answer these questions over the phone: 440-686-1074