Fitness Center Assessment Form
Fitness Center Assessment Form
Please complete this form to assess your fitness levels and help us tailor a program for your needs.
Name
Age
Phone number
Health History
Do you have any medical conditions?
If yes, please specify.
Have you had any surgeries or injuries?
If yes, please specify.
Are you currently taking any medications?
If yes, please specify.
Fitness Assessment
Current Weight
Height
Body Composition (if known)
Flexibility
e.g., sit and reach test
Cardiovascular Endurance
e.g., 1-mile run
Lifestyle Habits
How many days per week do you exercise?
What types of activities do you perform?
Average hours of sleep per night
Rate your stress level
Goals
What are your fitness goals?
Check all that apply.
-
Weight loss
-
Muscle gain
-
Improved endurance
-
Overall health
-
Consent
I hereby confirm that the information I have provided is accurate, and I willingly give my consent to participate in the fitness programs offered.
Name:
Date:
Thank you for your submission!
We appreciate you taking the time to submit.
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