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> Fitness screening template
Fitness screening template
Personal Information
Full Name
Provide first, middle, and last name.
Ensure correct spelling.
Use legal name as per identification.
Date of Birth
Enter in MM/DD/YYYY format.
Double-check for accuracy.
Ensure age eligibility for fitness program.
Gender
Select from provided options.
If non-binary, specify if allowed.
Ensure it's inclusive and respectful.
Contact Information
Provide phone number and email address.
Include preferred contact method.
Verify all information for accuracy.
Emergency Contact Information
Provide name and relation to the contact.
Include phone number and address.
Ensure availability of the contact person.
Medical History
Any pre-existing medical conditions?
History of heart disease or stroke?
Any surgeries in the last 5 years?
Current medications being taken?
Allergies (medications, foods, etc.)?
Physical Activity Readiness
Have you experienced chest pain during physical activity?
Have you ever felt faint or dizzy during exercise?
Do you have any joint or muscle pain that affects movement?
Are you currently engaging in regular physical activity?
Have you ever been advised by a healthcare provider to avoid exercise?
Lifestyle Assessment
Current level of physical activity (sedentary, moderately active, active)?
Dietary habits (balanced diet, special diet, etc.)?
Alcohol consumption (frequency and amount)?
Tobacco use (smoking or vaping)?
Sleep patterns (average hours of sleep per night)?
Fitness Goals
What are your primary fitness goals (weight loss, muscle gain, improved endurance, etc.)?
Any specific timelines for achieving these goals?
Previous fitness experience (types of exercises or sports)?
Barriers to achieving fitness goals (time, motivation, resources)?
Support systems available (friends, family, trainers)?
Consent and Acknowledgment
Signature for consent to participate in fitness screening
Date of consent
Acknowledgment of understanding the risks associated with physical activity
Agreement to disclose any changes in health status promptly
Additional Notes
Any additional comments or concerns from the participant
Notes from the fitness professional conducting the screening
Recommendations for follow-up or further assessments
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