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 Year212621252124212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926An 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