Contact Us

Hours and Locations


Brownings Madison Avenue:
980 Madison Avenue
New York, NY 10075
(315) 292-7547
Hours: Mon-Fri, 5:00AM-9:00PM
Weekends, 7:00AM – 5:00PM

Brownings Southampton:
60 Windmill Lane
Southampton, NY  11968
(315) 955-6989
Hours: By Appointment Only

Get in Touch


3 + 3 =

To schedule a Training Session:

Phone: (315) 292-7547
or
Email: appointments@browningsfitness.com

Profile


Profile Sheet
Brownings Client Profile
  • Basic Information
    0
  • Name*
    1
  • Date*
    2
  • Email*
    3
  • Phone*
    4
  • Age*
    5
  • Height*
    6
  • Weight*
    7
  • Ideal Weight*
    8
  • D.O.B.*
    9
  • How did you hear about us?*
    10
  • Medical History
    11
  • Do you take any vitamins?*(please list)
    12
  • Do you have any injuries?*(please list)
    13
  • Is there history of Heart Disease in your family?*(please list)
    14
  • Have you ever had a definite or suspected heart attack or stroke?*
    15
  • Have you ever had any type of heart surgery?*(please specify)
    16
  • Do you have any other cardiovascular or pulmonary (lung) disease?*
    17
  • Do you have a history of:*
    Diabetes
    Thyroid
    Kidney
    Liver Disease
    18
  • Have you ever been told by a health professional that you have had an abnormal resting or exercise (treadmill) electrocardiogram (EKG)?*
    19
  • Do you currently have any of the following:*
    Pain or discomfort in the chest or surrounding areas that occurs when you engage in physical activity?
    Shortness of breath?
    Unexplained dizziness or fainting?
    Difficulty breathing at night except in upright positions?
    Swelling of the ankles? (recurrent and unrelated to injury)
    Heart palpitations (irregularity or racing of the heart on more than 1 occasion)
    Known heart murmur
    Have you discussed any of the above with your personal physician?
    20
  • Are you pregnant or is it likely that you could be pregnant at this time?*
    21
  • Within the past 12 months, has a health professional told you that you have high blood pressure (systolic > 140 OR diastolic > 90)?*
    Yes
    No
    22
  • Currently, do you have high blood pressure or within the past 12 months, have you taken any medicines to control your blood pressure?*
    23
  • Have you ever been told by a health professional that you have a fasting blood glucose greater than or equal to 110 mg/dl?*
    Yes
    No
    24
  • Have you had surgery or been diagnosed with any disease in the past 3 months?*
    25
  • Have you had high blood cholesterol or abnormal lipids within the past 12 months or are you taking medication to control your lipids?*
    26
  • Are you currently under any treatment for any blood clots?*
    27
  • Do you have any problems with bones, joints, or muscles that may be aggravated with exercise?*(if yes, please specify)
    28
  • Do you have any back / neck problems?*(if yes, please specify)
    29
  • Have you been told by a health professional that you should not exercise?*(if yes, please specify)
    30
  • Are there any other conditions (mitral valve prolapse, epilepsy, history of rheumatic fever, asthma, cancer, anemia, hepatitis, etc.) that may hinder your ability to exercise?*
    31
  • During the past 6 months, have you experienced any unexplained weight loss or gain (greater than 10 pounds for no known reason)?*
    Yes
    No
    32
  • Do you currently smoke cigarettes or have you quit within the past 6 months?*
    Yes
    No
    33
  • Please list below all prescription and over the counter medications you are currently taking:*MEDICINE - REASON FOR TAKING - DOSAGE AMOUNT / FREQUENCY
    34
  • NUTRITION
    35
  • How much water do you drink a day?*
    36
  • How much alcohol in a week / day?*
    37
  • What foods do you love and hate?*
    38
  • What did you eat in the last 2 days for breakfast, lunch & dinner?*
    39
  • Do you cook?*
    Yes
    No
    Sometimes
    40
  • How often do you eat out?*
    41
  • Where do you live and work; what areas do you order from?*
    42
  • Fitness
    43
  • Describe your recent regular physical activity or exercise program:*TYPE - FREQUENCY - DAYS PER WEEK - DURATION / MINUTES - INTENSITY (LOW MODERATE HIGH)
    44
  • What exercise have you done in the last 6 months?*
    45
  • What days / times are you able to workout?*(please list all possible options)
    46
  • What is your goal?*
    47
  • Trainer preference*
    Male
    Female
    Either
    48
  • 49