Gender & Age

Measurements

This will including Waist to Hip ratio to help me calculate your BMI (Body Mass Index).
Using a tape measure, Please measure the following 3 areas:

Weight & Height

Your Waist - Do this by Place place your ring finger just above your belly button, next to it your middle finger and then your index finger, place the tape measure around your body so that it sits above all three fingers. What is the measurement in cm around this area?

Umbilicus - Take this measurement so that the tape measure goes around your belly button

Hips - Place the tape measure around you body so that it lies just touching the top of your hip bones

Health:

Do you have any health conditions. I.e Heart or lung problems or any Mental health issues? Please specify.......................

Do you currently have any injuries or have you had any in the last 6 months ? Please give details................

Have you had any operations in the last 3 years? Please give details.....................

Do you smoke? Please give amount per week?

Do you drink, if so please specify units per week?

Are you pregnant?

What type of things make you feel stressed?

How do you deal with your stress?

Activity level:

Do you enjoy any leisure activities or play any sports? If so please specify which and how many times per week?

Activity within your workplace: What is your job role and please give details on your activity level during the day?

What is your activity level at home?

Fitness Level:

Do you currently have an exercise program?
If yes, Please give me details on the workouts you do. How many times per week and for how long.

What type of exercises interest you?
       Walking
       Jogging
       Swimming
       Cycling
       Strength training
       Rowing
       Tennis
       Golf
       Stretching
       Other

If you are not currently exercising but have in the past, what made you stop?

Which Activities or exercise do you consider to be fun?

What motivates you?

Do you have any negative feelings towards, or have you had any bad experiences with an exercise programs?

Using the scale of 1 to 10 (where 1 is very important & is not important), how do you rate each of the following goals:
       a. Improve cardiovascular fitness
       b. Body fat weight loss
       c. Reshape/tone my body
       d. Sport specific
       e. Ability to cope with stress
       f. Improve flexibility
       g. Increase strength
       h. Increase energy level
       i. Feel better
       j. Improve posture
       k. Enjoyment
       l. Other

Anything else you would like your trainer to know?

Eating Habits:

Do you feel you eat healthy most of the time?

Do you eat 5 portions of fruit and veg per day?
If No, how many portions would you say you eat?

Do your emotions effect the way you eat?
Please give details.

How many times per week do you eat Red Meat?
1       2        3        4        5       more than 5

How many times per week do you eat fast food or takeaways?
1       2        3        4        5       more than 5

How many times per week do you have a chocolate bar?
1       2        3        4        5       more than 5

How many times per week do you have fizzy drinks?
1       2        3        4        5       more than 5