Client Health Form PDF Details

Do you know what your clients are eating? Do they have time to eat healthy meals or do they just grab something quick on their way out the door. If you're looking for a fast and easy way to keep track of this information, take advantage of our Client Health Form! This form is designed specifically for fitness professionals and will help them understand the health profile of their clients. It's also perfect for personal trainers who want to keep better track of how well their client has been following through with their nutritional goals.

Below is the data relating to the file you were seeking to fill in. It will tell you how much time it will need to finish client health form, what parts you need to fill in and several further specific facts.

QuestionAnswer
Form NameClient Health Form
Form Length5 pages
Fillable?Yes
Fillable fields92
Avg. time to fill out19 min 43 sec
Other namespersonal training health form, training health form, personal trainer health history questionnaire, personal training health history

Form Preview Example

Personal Training Client Health History Form

Please answer each question by printing the necessary information. Your answers will be kept confidential.

Client Information and Release Form

Name ___________________________________________ Birth Date _____________ Gender _________

Address ________________________________________________________________________________

City __________________________________________ State ________ Zip ________________________

Phone Number(s) Home___________________ Work __________________ Cell __________________

E-mail __________________________________________________________________________________

Employer _____________________________________ Occupation_________________________________

In case of emergency, please notify:

Name___________________________________________ Relationship ____________________________

Address ________________________________________________________________________________

City __________________________________________ State ________ Zip ________________________

Phone Number(s) ___________________ Home __________________ Work __________________ Cell

Please note: In order to assist you in the development of a rewarding physical fitness program, we need to have your honest and accurate responses.

General Medical History & Information

Are you under the care of a physician, chiropractor, or other health care professional for any reason?

If yes, list reason:__________________________________________________________________________________

Are you aware of any disease or disorder that would complicate your participation in a testing or exercise program?________________________________________________________________________________________

Has your doctor ever told you that you have a bone or joint problem that has been or could be made worse by exercise?______________________________________________________________________________________

Are you taking any medications? If yes please indicate the type of medication, dosage, frequency and reason(s) for taking it. _____________________________________________________________________________

Please list any allergies____________________________________________________________________________

Has your doctor ever said your blood pressure was too high? __________________________________________

Are you over age 65? _________________ Are you unaccustomed to vigorous exercise? ____________________

Is there any reason not mentioned here why you should not follow a regular exercise program?

If so, please explain ________________________________________________________________________________

Please describe any past or current musculoskeletal conditions you have incurred such as muscle pulls, sprains, fractures, surgery, back pain, or general discomfort:

Head / Neck _____________________________________________________________________________

Upper Back _____________________________________________________________________________

Shoulder / Clavicle _______________________________________________________________________

Arm / Elbow _____________________________________________________________________________

Wrist / Hand _____________________________________________________________________________

Lower Back _____________________________________________________________________________

Hip / Pelvis ______________________________________________________________________________

Thigh / Knee ____________________________________________________________________________

Lower Leg / Ankle / Foot

Please circle any areas of pain, injury, tension, or restriction of movement.

Have you recently experienced any chest pain associated with either exercise or stress?

If so, please explain ________________________________________________________________________________

Do you have a family history of any of the following conditions?

Heart Disease __________

Heart Attack __________

Hypertension __________

Gout __________

Abnormal EKG __________

Asthma __________

High Cholesterol __________

Angina __________

Diabetes __________ Other heart conditions __________

 

Do you have a family history of cardiovascular disease? If so, how many occurrences and what approximate ages? _______________________________________________________________________

Are you a smoker? If so, what is your smoking frequency? _____________________________________

Are you on any specific food / nutritional plan at this time? _____________________________________

Do you take dietary supplements? If yes, please list ___________________________________________

________________________________________________________________________________________

How many beverages do you consume per day that contains caffeine? ___________________________

Do you experience any frequent weight fluctuations? __________________________________________

Have you experienced a recent weight gain or loss? ___________________________________________

If yes, list change ___________________________________Over how long? _________________________

Your answers to these questions will be discussed with you prior to your session. Thank You.

Please take a moment to carefully read the following information and sign where indicated.

I understand that the personal training I receive is provided for the purpose of exercise instruction and guidance. I further understand that personal trainers are not qualified to perform, diagnose, prescribe, or treat any physical or mental illness, or provide nutritional planning, and that nothing said in the course of the session(s) given should be considered as such. I should see a physician, chiropractor, registered dietitian or other qualified medical specialist for any nutritional concerns, mental or physical ailment that I am aware of. I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the personal trainer updated as to any changes in my medical profile, and understand that there shall not be liability on the personal trainer’s part should I forget to do so. I understand that I have enrolled in the personalized health and fitness program offered through Holistic Fitness & Massage LLC, The Salon, Spa & Fitness Studio, and/or Franck’s Gym and it’s personal trainers and affiliates. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I herby affirm that I am in good physical condition and do not suffer from any know disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation in purely voluntary and in no way mandated by Holistic Fitness & Massage LLC, The Salon, Spa & Fitness Studio, and/or Franck’s Gym and it’s personal trainers and affiliates. In consideration of my participation in this program, I hereby release Holistic Fitness & Massage LLC, The Salon, Spa & Fitness Studio, and/or Franck’s Gym and it’s personal trainers and affiliates from any claims, demands, and causes of action as a result of my voluntary participation and enrollment of the provided personal training services and/or exercise classes. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release Holistic Fitness & Massage LLC, The Salon, Spa & Fitness Studio, and/or Franck’s Gym and it’s personal trainers and affiliates from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death. I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.

Signature______________________________________________________

Date _____________________

Consent for minors is required prior to first session.

Signature of Guardian____________________________________________ Date _____________________

Printed name of Guardian __________________________________________________________________

Phone number the Guardian can be reached in case of emergency __________________________________

© 2009 Holistic Fitness & Massage LLC

Client Profile Questionnaire

Current Exercise Information

Please explain your current exercise regimen including all strength training, cardiovascular training or other sporting activities that you perform.

Day of the Week / Activity / Length of Time

Body Type / Activity Level / Goal Information

What are your goals? (Circle those that apply)

Body Fat Loss

Muscle Gain

Strength Production

Increase Flexibility General Health Maintenance

How active are you and/or what is your exercise lifestyle like? (Circle those that apply)

Sedentary

Moderate Exercise

Competitive Exercise

Bodybuilding

Does your job require you to be….. (Circle those that apply)

 

Sedentary

Somewhat Active

Active

Very Active

 

Please answer yes or no to the following questions:

Is it hard for you to gain weight?

Can you eat a lot and still not gain weight?

Do you gain or lose weight according to your fluctuations in activity and food consumption? Is it hard for you to lose weight?

Do you gain weight if you’re not careful about food intake?

Current Nutritional Consumption

Please list the foods, beverages, supplements etc that you take on the average day.

Time / Qty / Food-Beverage-Supplement

Food Likes / Dislikes / Restrictions

Please list the foods you prefer to eat.

Please list the foods you DO NOT prefer to eat.

Please list any foods that you must restrict for any reason i.e. medical etc.

Have you ever been told to follow a specific nutritional plan in the past? If so, please indicate the reason and the type of plan and who had provided it for you.

Please take a moment to carefully read the following information and sign where indicated.

I am purchasing the services of Kristy Medo and Holistic Fitness and Massage to design a program to aid in weight management to enhance my fitness goals. I will not hold Kristy Medo or Holistic Fitness and Massage personally liable for any problems, illnesses or injuries that might occur due to a sudden change in my eating or exercise habits. This program does not replace the advice of a medical doctor, registered dietitian or other medical provider or treatment. I have revealed any and all necessary information about myself to prevent any possible complications to Kristy Medo and Holistic Fitness and Massage.

Signature______________________________________________________

Date _____________________

2/09

How to Edit Client Health Form Online for Free

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Step 1: First, press the orange button "Get Form Now".

Step 2: When you have accessed the new client personal training questionnaire edit page, you'll discover all actions it is possible to take regarding your document within the top menu.

Prepare the new client personal training questionnaire PDF and type in the content for each section:

part 1 to writing personal training health form

Within the field Address, City, Phone Number(s), Please note: In order to assist, Are you under the care of a, General Medical History &, If yes, and Are you aware of any disease or enter the information the platform asks you to do.

Entering details in personal training health form stage 2

You'll be requested to provide the information to let the application fill in the area Has your doctor ever told you that, Are you taking any medications, Please list any, Has your doctor ever said your, and Are you over age 65.

part 3 to filling out personal training health form

Please be sure to record the rights and responsibilities of the parties in the Is there any reason not mentioned, Please describe any past or, Head / Neck, Upper Back, Shoulder / Clavicle, Arm / Elbow, Wrist / Hand, and Lower Back section.

step 4 to filling out personal training health form

End by checking the following areas and filling them in as required: Hip / Pelvis, Thigh / Knee, and Lower Leg / Ankle / Foot.

Finishing personal training health form step 5

Step 3: If you're done, click the "Done" button to transfer the PDF file.

Step 4: Make copies of the template. This will prevent possible future difficulties. We don't look at or disclose the information you have, hence feel comfortable knowing it will be secure.

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