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Personal Heath Fitness Assessment

Name
Address
City State Zip
Phone(format: 123-456-7890)
work cell home
Email
GenderFemale Male
DOB
HeightFeet Inches
Weight lbs.
Are you currently using a gym membership?
Yes No
Fitness Level
How Many Hours Per Week do You Spend:
Weight Training 1 2 3 4 5 6 7
Cardio Workout 1 2 3 4 5 6 7
Yoga 1 2 3 4 5 6 7
Pilates 1 2 3 4 5 6 7
Exersize Evaluation
On a Scale of 1 - 5
1 – Extremely comfortable/knowledgeable/high
2 – Somewhat comfortable/knowledgeable/high
3 – Neutral
4 – Somewhat uncomfortable/unknowledgeable/low
5 – Extremely uncomfortable/unknowledgeable/low
How comfortable are you with exercising
1 2 3 4 5 6 7
Knowledge of what exercises to do
1 2 3 4 5 6 7
Level of motivation
1 2 3 4 5 6 7
Have you ever used whole body vibration fitness equipment? Yes No
Do you have physical injuries, limitations or recent surgeries Yes No
Are you pregnant? Yes No
Do you have a pacemaker? Yes No