Medical History

Fitness & Gym Health Assessment

Answer a few quick questions and get your personalized fitness score, diet plan, and workout insights.
Full Name*

PrefixFirst NameLast Name
Contact Number*
Email*
What is your age?*
What is your gender?*
Height*
Weight*
OCCUPATION*

SEDENTARYLIGHT ACTIVEHEAVY ACTIVE WORK
AVERAGE DAILY WATER INTAKE*

Less than 500 ml500 ml - 1 lts1-2 lts2-3 lts3-4 ltsMore than 4 lts
DIETARY PREFERENCE*

VEGETARIANNON VEGETARIANEGGETERIANVEGAN
Food Allergies
DAILY SLEEP HOURS*

4-5 hrs5-6 hrs6-7 hrs7-8 hrsMore than 8 hrsLess than 4 hrs
Check the conditions that apply to you:*

AsthmaCancerCardiac diseaseDiabetesHypertensionPsychiatric disorderEpilepsyI dont have any of these conditionsOther
Check the symptoms that you' re currently experiencing:*

Chest painRespiratoryCardiac diseaseCardiovascularHematologicalLymphaticNeurologicalPsychiatricGastrointestinalGenitourinaryWeight gainWeight lossMusculoskeletalOther
Are you currently taking any medication?*

YesNo
Please list them.
Do you have any medication allergies?

YesNoNot Sure
Please list them.
Do you use any kind of tobacco or have you ever used them?*
What kind of tobacco products? How long have you used/been using them?
Do you use any kind of illegal drugs or have you ever used them?
What kind of drugs? How long have you used/been using them?
How often do you consume alcohol?*

DailyWeeklyMonthlyOccasionallyNever
What is your Fitness goal*

Weight LossMuscle GainEnduranceFlexibilityGeneral FitnessOther
How many days a week do you work out?*

1234567
What type of exercise do you do most?*

Weight TrainingCardioHIIT (High Intensity Interval Training)YogaMixedOther
Do you currently follow a specific diet plan?*

KetoHigh-ProteinIntermittent FastingNo diet plansOther
Do you take any supplements*

Protein PowdersCreatinineVitaminsOther
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Fitness & Gym Health Assessment