Health and Fitness Evaluation Mind of an professional athlete

Health and Fitness Evaluation

 

Health and Fitness Evaluation

This form is used to evaluate your health and assist in planning your workouts. All information will be kept confidential. Fill in, circle, and/or check the appropriate words or boxes.
  • Date Format: MM slash DD slash YYYY
  • Past and Present History

  • Illness/Disease/ LimitationPast treatmentCurrent treatment 
  • InjuriesPast treatmentCurrent treatmentNo | None 
  • Pain locationPast treatmentCurrent treatmentNone 
  • Surgery TypeYearDetailsNo Surgery 
  • If pregnant, please state due date: 
  • MedicationsExercise RestrictionsDetailsNone 
  • NoYes, moderate (brisk walking intensity)Yes, vigorous-intensity (jogging intensity) 
  • Activity (gym/yoga/walk/garden etc)Per weekDuration 
  • What other types of exercise have you done in the past? (e.g. sports) 
  • NoYes, details please 
  • NoYes, details please 
  • NoYes, details please 
  • Please rate the following: 1 you disagree to 10 strongly agree

  • (½ oz for each LB of my body weight)
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

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