Fitness Assessment Form
Client Information
Name
First Name
Last Name
Age
Weight (lbs)
Height (in)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
Email
example@example.com
Health-Related Questions
Do you have any of the following conditions?
Cardiovascular problems
Hypertension
Respiratory issues
Other
Do you have any previous injuries or limitations? If yes, please explain
Are you currently taking medications? If yes, what are the medications and for what purpose?
Do you smoke tobacco?
Yes
No
Diet Habits & Struggles: (briefly describe your current diet habits and any struggles you have with maintaining a healthy diet.)
Training Experience
Beginner
Intermediate
Advanced
Current Activity Level:
Sedentary (little to no exercise)
Occasional workouts (1-2 times a week)
Consistent (3 or more times per week)
What are your goals in this program?
Weight loss
Gain muscles
Be physically fit
Sport performance
Improve overall health
Client Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: