Client Discovery | Solid Foundation Holistic Fitness Training

Personal Information

Full Name *

Date of Birth *

Height

Weight

Fitness Level *

Email Address *

Phone Number *

Goals

Primary Goal *

Tell us more about your goal (optional)

Emergency Information

Emergency Contact Name

Emergency Contact Phone

Physician Name

Physician Phone Number

Health History

1. Do you have a history of any of the following? If yes, please describe.

2. If a woman — are you currently pregnant?

Yes No N/A

How many weeks?

3. Are you currently on any medications?

Yes No

Name the medication(s) and what they're for

4. Do you have medical approval to participate in this program?

Yes No

If no — do you plan to seek medical approval?

Yes No

If you answered "Yes" to any of the health-history questions above, it is highly recommended that you seek medical approval before participating in any exercise program.

Lifestyle & Activity

5. Do you smoke?

Yes No

How many cigarettes a day?

6. In your opinion, are you more than 20 lbs overweight?

Yes No

How much weight would you like to lose?

7. Do you perform regular aerobic exercise?

Yes No

Times per week

Length of each session

Please describe the activities

8. What statement best describes your blood pressure?

Normal or low Borderline high High Not sure

9. What statement best describes your total cholesterol?

Normal or low Borderline high High Not sure

10. Do any positions, exercises, or activities cause you pain or anxiety?

Yes No

Please describe

Injury & Condition History

11. List any current or previous injuries or conditions that may limit your performance and/or range of motion.

Let's get to know your health & goals