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Client information & medical record
How will you attend?
Is this your first time attending?
Has your doctor ever said you should consult them before undertaking activity?
Do you feel pain in your chest during physical activity?
Do you have high blood pressure?
Do you lose balancee, feel light headed or have dizzy spells?
Have you been in hospital in the last 12 months?
Has your doctor ever said you have heart trouble?
Are you currently taking medicine?
Do you suffer from arthritis that is aggravated by exercise?
Are you pre or post natal?
Do you suffer from asthma or breathing difficulties?
Do you suffer from diabetes?
Do you suffer from epilepsy?
Are you healthy enough to train at Body Evolution Fitness
Are you experiencing any stress at the moment? Any mood swings, relationship or work issues for which you would like to recieve some help or resources?
has anyone in your family developed heart disease prior to 60 years old?
Are you taking or recently used any prerscription or over the counter medications?
Have you had any surgical operations in the past 10 years?
Are you currently under doctors care? If so, please give details below.
Have you any concerns that you would like to discuss with me or a doctor?
Do you currently smoke?
Do you drink alcohol?

Personal Goals

Tell me in number order what are your 3 main goals and the timescale that you would like to achieve them in?

Past Exercise History

Are you currently exercising / training? If no skip this section
How long have you been training / exercising?
How many times per week do you train?
Which types of exercising / training do you do?


Do you work night shifts?
Do you work from home?
What are your daily stress levels?
How many average daily walking steps do you do or think you do per day?
How many average hours do you sleep every night?
Do you get bloated or gassy?


Social support

Do the people who spend time with each day follow a healthy lifestyle by exercising or eating healthy foods?