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Physical Fitness Assessment Form: Health Information

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26atom Fitness factory

This document contains a physical fitness assessment form that collects information about a client such as name, age, sex, health details, posture, flexibility, mobility, balance, muscle endurance, cardiovascular endurance, measurements, fitness goals, fitness history, and lifestyle. The form is used to evaluate a client's current physical state and develop an appropriate fitness program.

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Physical Fitness Assessment Form: Health Information

Uploaded by

26atom Fitness factory
200 views6 pages
This document contains a physical fitness assessment form that collects information about a client such as name, age, sex, health details, posture, flexibility, mobility, balance, muscle endurance, cardiovascular endurance, measurements, fitness goals, fitness history, and lifestyle. The form is used to evaluate a client's current physical state and develop an appropriate fitness program.

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Assessment sheet

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This document contains a physical fitness assessment form that collects information about a client such as name, age, sex, health details, posture, flexibility, mobility, balance, muscle endurance, cardiovascular endurance, measurements, fitness goals, fitness history, and lifestyle. The form is used to evaluate a client's current physical state and develop an appropriate fitness program.

Copyright:

© All Rights Reserved
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
200 views6 pages

Physical Fitness Assessment Form: Health Information

Uploaded by

26atom Fitness factory
This document contains a physical fitness assessment form that collects information about a client such as name, age, sex, health details, posture, flexibility, mobility, balance, muscle endurance, cardiovascular endurance, measurements, fitness goals, fitness history, and lifestyle. The form is used to evaluate a client's current physical state and develop an appropriate fitness program.

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BRANCH: DATE:

PHYSICAL FITNESS
ASSESSMENT FORM
NAME: CONTACT:

AGE:

SEX:

MEMBERSHIP VALIDITY: FROM TO

HEALTH INFORMATION
ARE YOU UNDER ANY MEDICATION? IF YES SPECIFY

DO YOU HAVE ANY HISTORY OF SURGERIES?


DO YOU HAVE ANY MUSCLE TEAR OR JOINT INJURIES ?
OTHERS – SPECIFY.

POSTURE ANALYSIS

NECK SCAPULA
FLEXION NORMAL L R

LATERAL FLEXION PROTRACTED L R

POKE CHIN ELEVATED L R

LATERAL ROTATION WINGING L R

SPINE
KYPHOSIS
KNEE
LORDOSIS
GENUVALGUM L R
SCOLIOSIS
GENUVARUM L R
KYPHOSCOLIOSIS
FOOT
FLAT FOOT L R

NORMAL L R

INVERSION L R

EVERSION L R

FLEXIBILITY TEST

JOINTS EXCELLENT GOOD POOR


STANDING TOE
TOUCH
SIT AND REACH
DEEP LUNGE
COBRA STRETCH

SHOULDER MOBILITY
MOBILITY TEST EXCELLENT GOOD POOR
APLEY’S SCRATCH TEST
SHOULDER FLEXION
SHOULDER
EXTENSION

BALANCE
PROPRIOCEPTION R.LEG L.LEG
(EYES CLOSED)
SINGLE LEG STANDING

MUSCLE ENDURANCE TEST


TEST REPS DURATION
PULL - UPS
PUSH-UPS
SQUATS
CRUNCHES
CORE ENDURANCE TEST

TEST DURATION
IRON MAN
SIDE PLANK (R)
SIDE PLANK (L)
TRUNK FLEXOR ENDURANCE TEST

CARDIO VASCULAR ENDURANCE TEST


CARDIO MACHINE DISTANCE TIME DURATION
TREADMILL

HR CALCULATION:
MEASUREMENT

D.O.M

HEIGHT

WEIGHT

BMI

FAT %

NECK

SHOULDER

CHEST
NORMAL

EXPASION

MID ARM
CIRCUMFERENCE

ARMS(F)

TORSO
CIRCUMFERENCE

HIP
CIRCUMFERENCE

WAIST
CIRCUMFERENCE

MID THIGH
CIRCUMFERENCE

CALF
CIRCUMFERENCE
GOALS
1.What are your concern and goals? (Examples : Fat Loss, Strength, Power, Muscular
Endurance, cardio fitness, Flexibilty, Agility, Core stability or balance)

2.Why do you want to achieve these goals ? (Examples : General health, Injury, prevention /
rehab, sport-specific training, aesthetic reasons)

3.Which criteria will you use to measure the effectiveness of this program?(Examples :
body measurements 1 %, sports specific goals, increased energy level, stress reduction)

4.What areas do you want to concentrate on a emphasize? (i.d:Specific areas to strengthen,


joint stability, cardio or core conditioning, specific areas to mobilize)

FITNESS HISTORY
5.How long has it been since you have exercised regularly ? ( 2 or more times / weekly/
Month/ 6Months/ more than year )

6.Do you have experience with free weights or functional stability training ?

7.What type of cardiovascular exercise are you familiar with?

8.If you are an experienced exercised or athlete, what exactly is your current program?

9.Have you ever done any structured exercise in the past?(Yes or NO) If yes specify..

10.Are you currently involved in a regular exercise program? Yes/ No ) if yes specify..
11. Are you involved in any recreational sports ?

Running Cycling Swimming Badminton Tennis

Others

12. Are there any exercise that are contra indicated or not recommended by your physician
or physical therapist ?

LIFE STYLE
13. How would you describe your level of daily activites? (light (office work) Moderate
(manual labour) heavy ( construction) System work)

14. Rate your stress (1-5) for the following questions 1 2 3 4 5

Physical

Emotional

Mental / Career

15. Quantify caffiene intake per day

16. How often do you fall sick in a year?

17. Any gastrointestinal disorders?

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