Medical, Injury and lifestyle
Name
First Name
Last Name
Have you got any old or current injuries I should be aware of?
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Do you have any pre existing health conditions?
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No
Yes, state below
Please state what conditions you have in as much detail and as relevant to exercise as possible please. Please note these forms will be fully confidential.
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Please Tick all that apply
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Have you ever had a stroke
Have you or any one in your family experianced heart disease
Do you suffer from High or Low blood pressure
Do you have type 1 or type 2 diabetes
Do you have problems with fainting, dizziness or epilepsy
Do you suffer from arthritis
Have you ever had any major surgeries
Do you suffer from any mental health related issues
Do you smoke
Do you drink
Do you experience tightness or pain in the chest when exercising
Are you on any medication at the moment?
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What is your previous experience with sport or exercise
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How often do you exercise or play sport currently
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How would you rate your fitness at this current time
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2
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4
5
How would you rate your strength at this current time
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2
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4
5
How would you rate your current body image at this current time
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2
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5
How would you rate your current diet at this current time
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5
How many hours sleep are you getting per night?
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Please note that by signing this form you are agreeing that you have shared all of this information to the best of your knowledge, so myself the coach can best understand your situation, doing no harm with training or advise given ---------------------------------------------------------------------------------------------------- Signature
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Submit
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