New Client Assessment

FORCE FITNESS
BATON ROUGE

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Client Profile

** Please submit this form, and one of our fitness professionals will contact you to schedule an initial apponintment

* Indicates required field

Name *

First

Last

Address *

City, State, Zipcode *

e-mail address *

Phone Number *

Birthdate *

Gender *

Height *

Weight *

Body Fat % (if known) *

Personal Goals

What are your primary training and nutrition objectives? *

Build Muscle Fat Reduction Increase Cardiovascular Endurance Increase Strength Injury Rehabilitation Reduce Stress Shape & Tone Sport-Specific Training Weight Loss Other

Do you have a target date? If so, when? *

What is your training experience? *

None Beginner Intermediate Advanced Pre-competition

Do you currently participate in a structured resistance training program? *

Yes No

How often *

Everyday Once per week 2 to 3 times per week Once per month Less than once per month

For how long? *

Less than 1 month 1-6 months 1-3 years Over 3 years Never

Do you currently participate in a structured cardio training program? *

Yes No

How often *

Everyday Once per week 2 to 3 times per week Once per month Less than once per month

For how long? *

Less than 1 month 1-6 months 1-3 years Over 3 years Never

How often do you plan to train with Force Fitness? *

Everyday Once per week 2 to 3 times per week Once per month Less than once per month

What days of the week are you available to train? *

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

What time of day? *

Morning Midday Afternoon Evening

Where do you plan to conduct training? *

Home Office Other

Do you have your own weights/exercise equipment? *

Yes No

Specify *

Occupation

What is your occupation? *

If a student, what are you studying? *

Are you? *

Part-time Full-time

Does your work require extended periods of sitting? *

Yes No

Does your work require extended periods of repetitive movement? *

Yes No

Habits

How many hours of sleep do you get (avg)? *

Less than 4 4 - 6 6 - 8 8 - 10 More than 10

Do you or have you suffered from insomnia? *

Yes No Not sure

How many meals do you eat daily? *

0 - 2 3 4 5 6 or more

Do you snack between meals? *

Yes No Occasionally

How many calories do you eat daily (avg)? *

Do you have allergies/diet restrictions? *

Yes No

Specify *

Do you smoke? *

Yes No

If yes, how much? *

Are you currently taking vitamins/supplements? *

Yes No

If yes, what? *

Do you drink alcohol? *

Yes No

If yes, how often? *

Everyday Once per week 2 to 3 times per week Once per month Less than once per month

Do you drink coffee/energy drinks? *

Yes No

If yes, how many/day? *

0-1 drinks 2-3 drinks 4-5 drinks 6 or more

Medical History

Please check any ofthe following health problems you have, have had diagnosed, or have been treated by a health professional: *

Heart disease/attack Highblood pressure/hypertension High stress Heart Murmur Abnormal heart rhythm High cholesterol Arterial disease Chest pain Other heart problems Stroke Concussion/head injury Epilepsy Dizziness/vertigo Lung disease Asthma Cancer Diabetes Hypoglycemia Orthopedic problems Injury to back, knees, ankles Arthritis

Do you have a family history ofany of the following: *

Heart attack High blood pressure/hypertension Congenital heart disease Epilepsy Cancer Diabetes

Please list any operations: *

Please list any current injuries: *

Please list any current medications: *

Is there any reason not listed above that would restrict your ability to follow an exercise/fitness program. If so, please list: *

Submit

Force Fitness
2487 Tall Timbers Rd.
Baton Rouge, LA 70816
www.forcefitnessbr.com
225-444-5848

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Home
In-Home Training
Online Training
ENDURANCE SPORTS
Contact
FORMS
- New Client Assessment
- Nutrition Questionnaire
Wait 30 Min Before Entering