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Anamnesis Questionnaire
1.Personal Information
Full Name
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First Name
Last Name
Date of Birthday
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-
Month
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Day
Year
Date
Occupation
*
Contact (email and/or phone number)
*
2.Personal Goals
What are you main goals (check all that apply)?
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Weight loss
Muscle gain
Improving general fitness
Improving cardio endurance
Stress Management
Improving mobility/flexibility
Preparing for a sports event
Other
If you have a specific goal(s), what is your desired timeframe(s) to achieve it/them?
If you practice or wish to practice strength training, what are your primary goals (check all that apply)?
Targeting specific body part(s)
Functional training (strength and daily movement improvement)
Following a traditional gym program
Other
Please specify which specific part(s)
If you practice or wish to improve in cardio/endurance, what are your primary goals (check all that apply)?
Increasing stamina for daily activities
Preparing for a race or endurance event (e.g., marathon, triathlon)
Improving heart health or aerobic capacity
Other
3.Current Physical Activity Level
How often do you currently engage in physical activity?
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None
1-2 times per week
3-4 times per week
5 or more times per week
Other
What activities or sports do you usually practice?
4.Organization and Availability
How many sessions would you like per week?
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1-2 sessions
3-4 sessions
5 or more sessions
Other
How much time can you dedicate to each session?
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Less than 30 minutes
30-60 minutes
1 hour or more
Other
5.Health and Medical History
Do you currently have, or have you ever had, any injuries, pain, or physical limitations?
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Are you currently pregnant?
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Yes
No
Since when?
Do you have any diagnosed health conditions? (e.g., high blood pressure, diabetes, asthma, etc.)
*
Are you undergoing medical treatment or taking any medications regularly?
*
6.Lifestyle Habits
How many hours do you sleep on average per night?
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Less than 6 hours
6-7 hours
8 hours or more
Other
On a scale of 1 to 10, how would you rate your stress level? (1= very low to 10 = very high)
*
What is your current diet like (check all that apply)?
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Balanced
High in processed foods
Vegetarian/vegan
Other
7.Follow-Up and Remarks
Do you prefer to train (check all that apply):
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Alone
In a small group
With a personal coach
Would you be interested in (check all that apply):
Regular assessments (monthly or quarterly)
Nutritional coaching
Workshops or conferences on wellbeing
Do you have any other comments or specific needs?
Submit
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