Online Health Assessment

Thank you for visiting my personal training website.

Below is basic health check and goal assessment.

I will write back to you personally with your results, tips and advice relevant to your goals.

Fill in as much or as little as you like.

Contact Details
First Name
Second Name
Email Address
Basic Info
Age
Height
Weight
Cardiac Assessment If you don't have relevant testing equipment, just leave it blank.
Resting Heart Rate
Blood Pressure
Measurement Use cm or inches, bench marking your progress is critical to motivation and goal setting
Waist
Hips
Chest
Upper Leg (Thigh)
Arm (biceps)
LifeStyle Exercise plays a big part in how you feel and your stress levels.
Do you smoke	Yes No Sometimes
Alcohol (Units a week)
Stress Level ( 1 - 10 scale)
Daily Calorie Intake (approx)
I believe I am in good health
I eat at least one balanced meal per day
I usually get 7-8 hours sleep per night
I wake up feeling rested
I am able to organise my time effectively
I spend my leisure time enjoying relaxing activities
My head is clear, free from fuzziness, dizziness or headaches.
It is easy to control my temper
I've had feelings of panic or fear
I suffer from indigestion for no apparent reason
I am uptight, especially in my back, neck or limbs
I have feelings of general anger and hostility
I experience emotional outbursts
My stress level is impacted by conflict at work
My stress level is impacted by conflict at home
What do you want to achieve? Please rank how important the following goals are to you:
Weight Loss
Muscle Gain
Increase Fitness Levels
Stress's Management
Enhance Sport Performance
Improving lifestyle and outlook
Flexibility, suppleness and Core Strength
Got a different goal?
Preferred Training Types In order to recommend training to suit your goals please state how you feel about the following training options:
Personal Training
Outdoor Training
Walking
Running
CardioVascular Machines
Weights Machine or Free Weights
Small Group Personal Training
Classes in general
Current Fitness Levels
How you rank your current level of fitness
What are your current fitness activities?
What are your previous fitness activities?
Medical Conditions
Are you taking medication for anything which could effect your exercise ability?
Injuries
Do you have any injuries or problems which can inhibit your exercise performance? please give details for problem areas, treatment details and mobility now.
Anything Else
Is there anything else you would like me to know before I advise you or any other questions you have?