How do you spend your day at work?
Sitting at a desk walking/ active highly active
Hours of sleep do you get each night?
Hours per week___
How would you rate your daily stress level? Rate your daily energy level?
Do you enjoy exercising?___ How often do you perform resistance training?
How often do you perform moderate exercise? Vigorous exercise?
How would you rate your current fitness level?
Poor Below Avg. Moderate Above Avg. Excellent Competitive Athlete
List any other factors which might affect your safe participation in a fitness program?
Weight Height Body Fat Measurements: Waist
Thigh Chest Arms
Lowest weight Highest weight Favorite weight
Personal Goals: (circle all that apply)
Weight loss lbs. Improve strength General Fitness
Reduce risk of disease Improve Flexibility I m p r o v e c a r d i o V a s c u l a r H e a l t h
Improve posture Tone and firm Injury Rehabilitation __
Strengthen Bones Exercise regularly Balance and Stability
Other
Please list anything else that will help provide a better Fitness Program:
Rest HR Max HR Recovery HR