Fact Finder

Name:________________________________________DOB:____________ Gender: M F Height: _______ Weight________ PERSONAL MEDICAL PROFILE Do you have a heart condition? Yes No Do you feel pain in the chest when you do physical activity? Yes No Do you lose your balance because of your dizziness? Yes No Do you ever lose consciousness? Yes No Are you currently under any prescribed medication? Yes No Do you have any bone or joint problem? Yes No Do you Know any other reason that you should not do physical activities? Yes No PHYSICAL PROFILE Have you ever exercised? Yes No How many times per week do you exercise? (days) <2 3,4 5,6 7< How long are your usual training sessions? (Min) <20 30-40 50-60 70< GOAL IDENTIFICATION What type of exercise do you most enjoy? _____________________________________ What is your fitness goal? __________________________________________________ NOTES ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________