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Fitness Assessment
Exercise Planner
Meal Plan
Settings
Fitness Consultation Questionnaire
Name
Date
Gender
Consultant
Occupation & Lifestyle
Lifestyle Habits
Are you currently exercising?
Yes
No
If yes, how long have you been exercising?
Type of exercise
If no, how long since you exercised regularly?
What has prevented you from starting?
Have you worked with a Personal Trainer?
Yes
No
If yes, where?
How many times per week?
How was this experience?
Medical Background Review
Past or present do any of the following conditions relate to you?
High blood pressure
High Cholesterol
Asthma
Low Blood pressure
Osteoporosis
Diabetes
Stroke
Osteoarthritis
Insomnia
Neck or back pain
Arthritis
Ulcers
Hyper/Hypothyroidism
Please enter any conditions not stated
Have you had any surgery?
Yes
No
If yes, please describe
Goals
Goal 1
Goal 2
Goal 3
Goal 4
Limitations
Limitation 1
Limitation 2
Limitation 3
Limitation 4
Body Composition Assessment
Age
Height
Weight
Blood Pressure
Resting Heart Rate
Percentage of Body Fat
Fat Pound
Lean Pounds
BMR
Goal Weight
Weight to Lose
Measurements
Right Arm
Left Arm
Chest
Waist
Hips
Right Thigh
Left Thigh
Right Calf
Left Calf
Total Circumference
Notes
Save Data