International Sports Sciences Association
This form is adapted from ISSA client assessment materials
EXERCISE HISTORY INFORMATION
Are you currently involved in a regular exercise program?
Yes
No
Do you regularly walk or run 1 or more miles continuously?
Yes
No
If yes, what is the average number of miles you cover in a workout?
What is your average time per mile?
Do you practice weightlifting or calisthenics?
Yes
No
Are you involved in an aerobic program?
Yes
No
If yes, what type(s)?
Do you frequently compete in competitive sports?
Yes
No
If yes which one(s)?
Golf
Volleyball
Bowling
Football
Tennis
Baseball
Handball
Track
Soccer
Basketball
Other
In which of the following high school or college athletics did you participate?
None
Track
Football
Swimming
Basketball
Tennis
Baseball
Wrestling
Soccer
Golf
Other
Do you frequently compete in competitive sports?
Walking and/or Running
Bicycling (outdoors)
Swimming
Stationary Running
Stationary Biking
Tennis
Jumping Rope
Handball
Basketball
Squash
Other
Comments:
NAME:
SIGNATURE:
DATE:
-
Month
-
Day
Year
Date
SIGNATURE OF PARENT: or GUARDIAN (for participants under the age of majority)
WITNESS:
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