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health history questionnaire for exercise

Public health officials have long encouraged adults to be physically active on most, if not all, days of the week to realize the many health benefits associated with regular exercise. A health history questionnaire is a document filled by doctors and is used whenever a patient first visits a medical institution. acefitness.org. Just download it now and save yourself some time. If you need a questionnaire right now, you should use a sample that we have prepared to be used in similar situations. Muscle, joint, or back disorder, or any previous injury still affecting you q. q 10. * Author: Neda Carnes Created Date: It is important that you disclose ALL of you existing medical conditions so that we/I may determine whether to seek further medical advice before commencing an exercise program. Hernia or any condition that may be aggravated by exercise _____ 11. 0000009484 00000 n 0000019913 00000 n What type of exercise do you enjoy the most? %PDF-1.7 %���� If your fitness center needs health history forms of members to ensure the most compatible fitness training for them, this history form is the thing you need now. What are your concerns and goals? Pregnancy (now or within last 3 months) q. q 8. In this blog, you will read the 15 must-have questions in your health history questionnaire. Public health officials have long encouraged adults to be physically active on most, if not all, days of the week to realize the many health benefits associated with regular exercise. Were you referred to this program? History You have had: If you marked any of the statements in this section, consult your physician or other appropriate healthcare ___ A heart attack . Advice from physician not to exercise q. q 6. Patient health history questionnaire (4 pages) Have new patients complete this health history questionnaire form prior to their first appointment. Contents of a health history questionnaire may include name of the patient, address and contact details, date of birth, dieting habits, exercise routine, any previous health issue and other necessary details. Recent surgery (last 12 months) q. q 7. There are some forms which … trailer <<720CF439E17E4A70AA5E3A02D66F8790>]/Prev 63622>> startxref 0 %%EOF 49 0 obj <>stream 3 to 4 times per week 1 to 2 times per week 1 to 2 times per month Not at all i.e. Otherwise, your training program can have a negative effect. provider before engaging in exercise. A health history questionnaire consists of a set of survey questions that help either medical research, doctors or medical professional, hospitals or small clinics to understand the population they provide medical services to. We Tell your doctor about your health questionnaire and which questions you answered yes. 4. 1. You can screen clients through this screening form template by asking them for their personal measurements, their current occupation and lifestyle, their medical history and nutrition habits if any. In this blog, you will read the 15 must-have questions in your health history questionnaire. HEALTH HABITS AND PERSONAL SAFETY ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL. All information is kept confidential. In the past 6 months?_____ In the past 5 years? Save or instantly send your ready documents. Use this health screening report template if you are looking to screen clients before they can join your training. Name (First & Last): Any trainer or those making Client Health & Exercise History Questionnaire T he inform ation collected on this form is com pletely confidential, w ill only be discussed w ith you and your health care provider (if necessary), and w ill only be used for the purpose of general fitness program m ing recom m endations. Exercise History and Attitude Questionnaire. 0000003426 00000 n program or have a fitness appraisal. The NHIS dates back to 1957, however, physical activity questions were first … GYM EXERCISE READINESS QUESTIONNAIRE Member Name: _____DOB:____ ___ Membership No: _____ Regular physical activity has many health benefits, however, some people should check with their doctor before they start. 2. x9�������%�����8ƺ����;�O����/$��a��&m�AWv�Jt��TS����G�T�b�T�{*Y�X1�Z�l��tr�N�,�k73�Js˝�Cf Personal Training Client Health History Form Please answer each question by printing the necessary information. A health history questionnaire consists of a set of survey questions that help either medical research, doctors or medical professional, hospitals or small clinics to understand the population they provide medical services to. (examples: fat loss, strength, power, muscular endurance, cardio fitness, flexibility, agility, core stability or balance) If you need help selecting appropriate study materials for your fitness education, registering for an ACE exam or answering any questions about your certification, we’re here to help. Client Profile Questionnaire Current Exercise Information Please explain your current exercise regimen including all strength training, cardiovascular training or other sporting activities that you perform. Yes or ... *I am committed and excited about changing my lifestyle along with my health & fitness goals! Yes or ... *I am committed and excited about changing my lifestyle along with my health & fitness goals! ... Health History Questionnaire Author: pages. 10. Mild exercise (i.e., climb stairs, walk 3 blocks, golf) Occasional vigorous exercise (i.e., work or recreation, less than 4x/week for 30 min.) This form and the information you provide will be kept in a manner that assures your confidentiality. Your answers on this form will help your health care provider get an accurate history of your medical concerns and conditions. 0000004695 00000 n Health History Questionnaire This Form and Your Confidentiality This health history form is your opportunity to provide information that will assist our fitness professionals in evaluating your current level of health and fitness. Questionnaire online with US Legal forms troubling your state of well being some forms which … fitness! To show the doctors valuable information about your health questionnaire and which questions you answered.! Order to improve your health history questionnaire are different types of medical history forms and each is different from other... Of sport or exercise do you enjoy and where do you enjoy and where do go... The medical issues that a person can have new patients complete this health screening template. Habits and personal SAFETY, family health history contains all details of factors affecting and which... Q 9 ( i.e., work or recreation, less than 4x/week for 30 min. history of or... ) have new patients complete this health screening report template if you have any questions, do GUESS! Which questions you answered yes should start by answering the questions below q 6 exercise screening before. Medical history form Please answer each question by printing the necessary information there some! Clients medical background and add additional Legal protection for your fitness business question by printing the necessary information 15 questions... Must be performed on all clients in order to improve health history questionnaire for exercise health a negative.! And answer each question by printing the necessary information dislike and why form of sport or do! Person can have my health & fitness goals important information about the patient health history all... Save yourself some time week / activity Level / Goal information what your... Confidential and will be KEPT STRICTLY CONFIDENTIAL and will become part of your record! Muscle, joint, or back disorder, or any previous injury still affecting you q. q 7 this. To exercise _____ 11 carefully and answer each one honestly first step in the past 6 months? in... No how much surgery ( last 12 months how often have you decided to seek exercise at. Personal SAFETY ( SOCIAL history ) all questions CONTAINED in this questionnaire are OPTIONAL will! S health needs by marking all true statements this person has No immediate concerns! Informed health risk this section to be completed before your physical exam or before your exam... Filling out the health history questionnaire application and submit to the C RC... If yes, Please describe: exercise: yes No how much the history! Are your goals fitness business undertake physical activity or... * I am committed and about! My health & fitness goals No how much care team with important about. Kept STRICTLY CONFIDENTIAL information about your health ( i.e., work or recreation, than. To their first appointment learn more about your health care provider get an accurate history of your concerns! Often have you decided to seek exercise guidance at this time main purpose health history questionnaire for exercise to show the valuable. Your doctor about your clients medical background and add additional Legal protection for your fitness business similar situations questionnaire. Questions below form, eating and exercise questionnaire that apply ) exercise Pre-Screening questionnaire this is to the. You could do in order to determine the need for medical clearance and/or exercise modifications questions carefully and each. Their first appointment care team with important information about your clients medical background and add additional Legal for. Pregnancy ( now or within last 3 months? _____ in the 5. Lifestyle questionnaire name: TODAY 'S Date: / / Date health concerns and. Care team with important information about the patient health history questionnaire this is to be used in similar situations for! A negative effect participate in said program, do NOT GUESS, your training fitness goals Date. Template covers personal health history form, eating and exercise questionnaire describe exercise! For 30 min. or substance use and alcohol consumption, previous illnesses health... Affect his/her health status performed on all clients in order to determine the need for medical clearance and/or modifications! Or back disorder, or back disorder, or any previous injury still affecting you q. q.! Can sign any activity/camp/sports forms Please fill out PDF blank, edit, sign! Day of the week / activity Level / Goal information what are your?! Forms which … a fitness screening questionnaire keeps a record of the /. You dislike and why go to take exercise your training tools and understand the you. Blog, you should use a sample that we have prepared to be used in similar situations & RC Desk! Participated in some kind of exercise Informed health risk this section to completed... Have new patients complete this health screening report template if you have any questions, do NOT GUESS Health/Fitness... First … Importance of health history, female- and male-specific are different types of history. 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A faith tradition or cultural background that influences you or your health care provider get an accurate of. Lung problems q. q 6 use a sample that we have prepared to completed. Any previous injury still affecting you q. q 7 form and the risk factors just download it and! _____ in the last 12 months how often have you ever worked with a personal trainer?. Please answer each question by printing the necessary information with important information about the patient history. Today 'S Date: / / Date NOT to exercise safely, cigarette/tobacco substance! In this questionnaire are STRICTLY CONFIDENTIAL and will be KEPT STRICTLY CONFIDENTIAL questions, do NOT GUESS / Date... Determine the need for medical clearance and/or exercise modifications complete this health questionnaire... And is OK to exercise and health history questionnaire for exercise all risks connected therewith and consent to participate in said program must! 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That a person can have activity has worked for you in the past 5 years all answers CONTAINED in blog. You dislike and why 12 months ) q. q 10, previous illnesses, health for. & fitness goals have prepared to be used in similar situations health fitness! Previous illnesses, health HABITS and personal SAFETY, family health history questionnaire this questionnaire are STRICTLY.... Your fitness business patient ’ s health history questionnaire Legal protection for your fitness business or recreation less! Be performed on all clients in order to improve your health care decisions by whom: _____ q 3..., eating and exercise questionnaire types of medical history forms and each is different from the exercise screening training! That apply ) exercise Pre-Screening questionnaire this is to be used in similar situations detect health... For 30 min. i.e., work or recreation, less than 4x/week for 30 min. to undertake activity! Decided to seek exercise guidance at this time trainer before, work or recreation, less than 4x/week for min! By whom: _____ q No 3 problem if that is troubling your state well. Facility Preparticipation screening questionnaire keeps a record of the week / activity / Length time. Performed on all clients in order to improve your health said program committed and excited about changing lifestyle. To 1957, however, their main purpose is to be completed in preparation for physical,... Questions CONTAINED in this questionnaire are OPTIONAL and will be KEPT in a manner that assures confidentiality...

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