Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs
Sharp Performance Health History
Participant Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Please list all medications, supplements and drugs that you currently take: (Name, Dosage and Reason for taking)
Does your physician know you are participating in this exercise program? Yes No
Describe any physical activity you do somewhat regularly:
Do you now, or have you had in the past: Click "Yes" If Applicable.
Sharp Performance Exercise History and Training Goals
Please complete these forms as accurately as you can.
1. Please rate your exercise level on a scale of 1 to 5 (1 = not strenuous to 5 = very strenuous) for each age range though your present age:
5-8 9-12 13-15 16-18
2. Do you have any negative feelings toward, or have you had any bad experiences with physical activity programs?
Yes No
If yes, please explain below:
3. Do you have any negative feelings toward, or have any bad experience with, fitness testing and evaluation?
Yes No
If yes, please explain below:
4. Rate yourself in the following areas on a scale of 1 to 5 (1 = the lowest value and 5 = highest value). Choose the number that best applies.
|
Low/Not Important |
High/Important |
|
1 2 3 4 5 |
Your present athletic ability |
|
Your present cardiovascular capacity |
|
Your present muscular capacity |
|
Your present flexibility |
|
When you exercise, how important is competition? |
|
5. Do you start exercise programs but then find yourself unable to stick with them?
Yes No
6. How much time are you willing to devote to an exercise program?
minutes/day minutes/week
7. Are you currently involved in regular endurance (cardiovascular) exercise?
Yes No
If yes, specify the type of exercise(s)
minutes/day x per week
Rate your perception of the exertion of your exercise program (tick on the number):
(1) Light (2) Fairly light (3) Somewhat hard (4) Hard
8. How long have you been exercising regularly?
months years
9. What exercise, sport, or recreational activities have you/do you participate:
In the past 6 months?
In the past 5 years?
10. What days and times work best for you to meet with your trainer?
11. What types of exercise interest you?
12. Please list two short term goals (3-6 months) and two long term goals (one year +) for your performance program?
13. What do you want your training experience to do for you?
14. Please rank your training goals. Use the following scale to rate each goal.
Not Important |
Somewhat Important |
Extremely Important |
1 2 3 4 5 6 7 8 9 10 |
a. Improve cardiovascular fitness |
|
b. Lose weight/body fat |
|
c. Reshape or tone my body |
|
d. Improve performance for a specific sport |
|
e. Improve mood and decrease stress |
|
f. Improve flexibility |
|
g. Increase strength |
|
h. Increase energy level |
|
i. Feel better |
|
j. Enjoyment |
|
15. Would you like to change your current weight? Yes No
If yes, please indicate change below:
(+) lbs (-) lbs