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Classes
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HEALTH & Fitness STATUS
HEALTH PART I. Personal Information
Name
*
First Name
Last Name
Date
*
Todays Date
MM
DD
YYYY
Email
*
HEALTH PART II. Health Related Behaviour
Do you smoke?
*
YES
NO
IF YES is it less than previously?
Do you drink alcohol regularly?
*
YES
NO
IF YES is it less than previously?
How many times on average do you eat fast food per week?
*
1 Being never, 10 More
1
2
3
4
5
6
7
8
9
10
How many hours of sleep do you normally get per night?
*
1
2
3
4
5
6
7
8
9
10
HEALTH PART III. Psychological
Do you feel like your health has improved over the last period of training?
*
1 Disagree, 10 Agree
1
2
3
4
5
6
7
8
9
10
Do you feel like your day-to-day tasks have become easier? (walking, carrying objects etc.)
*
1 Horrible, 10 Great
1
2
3
4
5
6
7
8
9
10
How serious do you feel about achieving your goals after this block?
*
1 Not very, 10 Extremely
1
2
3
4
5
6
7
8
9
10
HEALTH PART IV. Goals
Have your goals changed since the previous block? (i.e. lower blood pressure, weight loss, build muscle, etc.)
*
YES
NO
IF YES please list
Do you wish to achieve any of these goals in a specific time frame?
*
YES
NO
IF YES please explain
FITNESS PART I. Fitness Information
Have you started any other form of physical activities other than the gym sessions?
*
YES
NO
If YES please list
FITNESS PART II. Psychological
How would rate your current physical fitness levels?
*
1 Horrible, 10 Great
1
2
3
4
5
6
7
8
9
10
How enjoyable is exercising to you?
*
1 Not Very, 10 Extremely
1
2
3
4
5
6
7
8
9
10
FITNESS PART III. Goals
Have your goals changed since the previous block (i.e. increase 10K time, bench press)?
*
YES
NO
IF YES please list
Do you wish to achieve these goals in a specific time frame?
*
YES
NO
IF YES please explain
FITNESS PART IV. Training Preferences
How do you know feel about being pushed (challenged) to the limit.
*
1 Disagree, 10 Agree
1
2
3
4
5
6
7
8
9
10
How comfortable do you feel in performing recommended exercises (i.e. cardio, stretching, etc.) in your own time.
*
1 Disagree, 10 Agree
1
2
3
4
5
6
7
8
9
10
FITNESS PART V. Questions
What part of training did you find enjoyable over the past block?
Are there any noticeable aches/pains or signs of feeling fatigued?
Is there anything regarding training you would like to see more of during the next block?
Is there anything regarding training that you would like to know more about during the next block?
Thank you!
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