Fitness Assessment Form

1

Nameالاسم

First Name

Last Name

2

Ageالسن

3

Genderالنوع

Male

Female

4

Jobالمهنه

5

Marital Statusالحاله الاجتماعيه

Married

Single

Divorced

6

Phone Numberرقم التيليفون

7

Would you prefer the workout at home or a at the gym ?هتفضلى التمرين ف الجيم ولا البيت؟

e.g.,3,4

8

How many times will you be able to exercise in a week?هتقدري تتمرنى كام مره ف الأسبوع؟

e.g.,3,4

9

For how long will you be able to exercise in a session?هتقدري تتمرنى لمده قد ايه ف الجلسه الواحده ؟

10

List the tools you have in case you'll workout at home.فى حاله انك هتفضلى تمرينه البيت، لو عندك أوزان او أدوات اكتبيها تحت👇

11

What are your goals in this program?الهدف من التمرين

Weight loss نزول وزن

Gain muscles زياده كتله عضليه

Be physically fit لياقه بدنيه

Sport performance رفع أداء رياضى

Improve overall health تعزيز الصحه

12

What's your most wanted goal?لو هنبدأ اول شهر بهدف واحد بس، تحبى نبدأ ب ايه؟ هل فيه منطقه معينه حاسه انها محتاجه شغل اكتر؟

13

Have you been previously hospitalized? If yes, please indicate when and why.هل قبل كده روحتى المستشفى؟ لو اه ليه؟

14

Do you have the following conditions?هل عندك اي مشاكل صحيه من الأتى ؟

Anemia انيميا

Cardiovascular problems مشاكل بالقلب

Diabetes Mellitus سكر

Hypertension ضغط

Bone problems مشاكل بالعظم

Respiratory issues مشاكل بالجهاز التنفسى

Other أخري

15

Are you a smoker?هل انتى مدخنه؟

Yes

No

16

Are you currently taking medications? If yes, list it below.هل بتاخدي ادويه؟ ايه هى؟

17

Have you had any injuries in your body? If yes, please indicate the locationهل عندك اي اصابات سابقه؟

18

Have you had any pain in your joints, lower back, elbows, knees, etc recently?هل عندك اي مشاكل بالعظام ؟ مفاصل؟

Yes

No

19

Did you undergo any surgeries in the past? If yes, please indicate the type of surgeryهل عملتى عمليات قبل كده؟

20

Any previous experience with resistance training?مارستى قبل كده تمارين مقاومه؟

Yes

No

21

Any previous experience with particular sports or physical activities?مارستى اي نوع رياضه قبل كده؟

Yes

No

22

Daily activity level ?معدل نشاط اليومى؟

23

When is your monthly menstrual cycle?ميعاد الدوره الشهريه؟

24

On a scale from 1 to 10, how much is your stress level?مؤشر القلق اليومى؟

Under 4

From 4 to 6

Above 6

10

25

How many hours of sleep do you get on average?عدد ساعات نومك ف اليوم؟

Under 6

From 6 to 8

8 or above

26

How many cups of water do you drink per day on average?بتشربي ميه قد ايه؟

Under 4

From 6 to 8

From 8 to 12

12 or above

27

Please upload a copy of your latest inbody

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Browse Files

28

Terms and Conditions* This field is required.