Fitness Assessment Form
Client Information
Name
First Name
Last Name
Age
Gender
Male
Female
Other
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Are you currently taking any exercise program?
*
Yes
No
Height (in)
*
Weight (lbs)
*
Health-Related Questions
Let's talk about your health
PLEASE PROVIDE ANSWERS TO ALL QUESTIONS!
This helps the coach to better understand you.
Do you drink alcohol?
*
Yes
No
Do you eat 3 meals a day? (Breakfast, Lunch, Dinner)
*
Yes
No
How many meals do you have in a day?
*
What do eat as snacks during the day?
*
Do you have much appetite for food or Less appetite for food?
*
Do you experience pain or soreness in any part of your body? If yes, Please Indicate the body part below.
*
What equipment do you have to train? (free weights, no equipment at all)
*
What are your goals in this program?
*
Loose weight
Build Strength & Muscle
Be physically fit & athletic
Build a Functional Body
Build Tone Body
How many days a week are you ready to give out for your health?
*
Client Signature
*
Date Signed
-
Month
-
Day
Year
Date
Submit
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