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    Online Client Form

    Uploaded by

    adelle23
    This document contains a client information form collecting details about a person's fitness goals, medical history, lifestyle habits, and physical measurements to develop a customized fitness and nutrition plan.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Online Client Form

    Uploaded by

    adelle23
    15 views4 pages
    This document contains a client information form collecting details about a person's fitness goals, medical history, lifestyle habits, and physical measurements to develop a customized fitness and nutrition plan.

    Original Description:

    quiz client fitness

    Original Title

    Online Client Form (1)

    Copyright

    © © All Rights Reserved

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    DOCX, PDF, TXT or read online from Scribd

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    This document contains a client information form collecting details about a person's fitness goals, medical history, lifestyle habits, and physical measurements to develop a customized fitness and nutrition plan.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    15 views4 pages

    Online Client Form

    Uploaded by

    adelle23
    This document contains a client information form collecting details about a person's fitness goals, medical history, lifestyle habits, and physical measurements to develop a customized fitness and nutrition plan.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    CLIENT INFORMATION FORM

    Name: Date:

    Address: Primary Phone

    Email: Secondary Phone #

    Personal Physician: How did you find me?

    Date of Birth: Age: Age you feel: Weight?

    Body fat % Occupation Height?

    Fitness Status
    What are your fitness goals?
    (Weight-loss, muscle-growth, toning, sports conditioning, lower blood pressure etc.)

    When do you want to achieve this by?

    Goal weight?
    Goal Body-fat?
    What are some of your problem areas?
    Where do you store the most body-fat? (Legs, hips, arms, belly, back etc.)
    Which body type are you the most like? (use image for reference)
    How many hours of physical activity do you perform excluding the
    gym/cardio?
    What are some exercises you would prefer for cardio?

    Medical History
    Have you had any family history of chronic disease (heart disease, diabetes, etc.)? YES / NO
    IF YES please list
    Have you ever been diagnosed or treated for any chronic disease including asthma? YES / NO
    IF YES please list
    Are you currently taking any medications? YES / NO
    IF YES please list
    Has a physician ever restricted you from performing physical activity? YES / NO
    IF YES please list

    Health Related Behavior


    Do you smoke? YES / NO IF YES how much?
    Do you drink alcohol? YES/NO IF YES how much?
    How many times on average do you eat fast food per week?
    Never 1 2 3 4 5 6 7 8 9 10 or more
    How many hours of sleep do you normally get per night?
    Never 1 2 3 4 5 6 7 8 9 10 or more
    What time do you go to sleep?
    What time do you wake-up?
    What time do you - Weight train? Cardio?
    How many days per week are you able to work-out?
    Psychological
    I am serious about my goals?
    Not 1 2 3 4 5 6 7 8 9 10 Extremely
    Very
    How would you describe your support from family/friends etc?

    Fitness Information
    What type of duties do you perform at work?

    Have you had any injuries related to physical activity? YES / NO


    If YES please list:
    IF YES, please explain: )

    NUTRITION STATUS
    Are there any foods that you cannot consume due to personal or religious reasoning?

    Are there any foods that you are allergic to? YES / NO

    What are some foods you prefer to eat?

    What are some foods you prefer NOT to eat?

    Nutrition Habits
    Please write all the foods you currently consume on a daily basis and the time you consume it.
    (Please be honest)

    Questions
    Please write any fitness, nutrition, or health related questions you would like answered.
    What are your measures (in centimeters) in terms of:
    - Chest:
    - Waist:
    - Hips:
    - Arms:
    - Legs:

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