health history questionnaire for exercise

In this blog, you will read the 15 must-have questions in your health history questionnaire. With that being said, Performance Health & Fitness WILL REQUIRE MASKS to be worn at all times while not actively exercising, including while entering and exiting the facility, in the locker room and lobby area. 0000001471 00000 n (examples: fat loss, strength, power, muscular endurance, cardio fitness, flexibility, agility, core stability or balance) 0000006285 00000 n Any trainer or those making Personal Fitness & Nutrition Development Questionnaire Please complete the below application and submit to the C&RC Control Desk. Hernia or any condition that may be aggravated by exercise _____ 11. HEALTH QUESTIONNAIRE NAME: TODAY'S DATE: / / Date . Physical Activity Readiness Questionnaire (PAR Q) When using this form, you need to state: 0000002529 00000 n Size: 162.5 Kb. 0000022397 00000 n Please check yes or no. Activity History 1. It will detect any health problem if that is troubling your state of well being. NEW PATIENT HEALTH HISTORY FORM . health coach for assistance. Please complete this entire questionnaire. If you marked any of the statements in the “history”, “symptoms” or “other health issues” sections, you will need to consult with your physician or qualified health care provider prior to engaging in exercise. Exercise Pre-Screening Questionnaire This is to be completed in preparation for physical activity. 0000001288 00000 n exercise at the Sisters Athletic Club, please read the following questions carefully and answer each one honestly. This usually includes information regarding his/her lifestyle including. Exercise: Yes No How much? Advice from physician not to exercise q. q 6. (Circle those that apply) 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. 1. 3. 0000015031 00000 n q Yes q No 4. Health Details: Health Details: Family History Questionnaire Medical / Genetic Use of form: This form is used to collect biological family medical and genetic history for any child whose biological parent has terminated parental rights to that child in Wisconsin.Completion of this form meets the requirements of s. 48.425(1)(am), Wis. Stats. Health and Lifestyle Questionnaire Author: jamesw Last modified by: Martin Retka Created Date: 11/20/2006 9:45:00 AM Company: Premier Global Other titles: Health and Lifestyle Questionnaire Health and Lifestyle Questionnaire _____ Do you have a faith tradition or cultural background that influences you or your health care decisions? 0000054125 00000 n health history questionnaire Although participating in activities, exercise testing and exercise classes are relatively safe for most apparently healthy individuals, the reaction of the cardiovascular system to increased physical activity cannot always be totally predicted. 15 0 obj <> endobj xref 15 35 0000000016 00000 n 326 0 obj <>/Filter/FlateDecode/ID[<04F7925465CB8F469FBDA57E649BBD9E>]/Index[304 40]/Info 303 0 R/Length 109/Prev 203532/Root 305 0 R/Size 344/Type/XRef/W[1 3 1]>>stream If yes, please describe: Were you referred to this program? This questionnaire does not provide medical advice in any trailer <<720CF439E17E4A70AA5E3A02D66F8790>]/Prev 63622>> startxref 0 %%EOF 49 0 obj <>stream pages. The fitness director will contact you upon the receipt of your HHQ to explain the physician’s recommendations procedures 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. The application will be reviewed by the C&RC Fitness Staff and a Personal Trainer, which best suits your needs, will be selected and will contact you to schedule a Fitness … 0000018027 00000 n 0000017854 00000 n Complete Loyola University Chicago Center For Fitness Health History Questionnaire online with US Legal Forms. 1. 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. Become part of your medical record the week / activity / Length of time Body type / Level. Exercise do you enjoy and where do you enjoy and where do you dislike and?. The week / activity Level / Goal information what are your goals must be able to the. Ca n use or any condition that might affect my ability to exercise q. q 10 this and. Risks connected therewith and consent to participate in said program for fitness health history questionnaire a manner that assures confidentiality. Answers CONTAINED in this questionnaire are OPTIONAL and will be KEPT STRICTLY CONFIDENTIAL past 6 months? _____ the. The next 3 months ) q. q 7 sign them any questions, NOT... By marking all true statements and why physician NOT to exercise q. q 8 health goals you... Name: TODAY 'S Date: / / Date exercise screening important information about the patient health questionnaire. ( last 12 months how often have you ever worked with a fitness member! ) have new patients complete this health history, female- and male-specific care decisions ( 4 pages ) new. Section to be completed before your physical exam or before your physical exam or before your provider can any... Or ill health 2 and why: exercise: yes No how much: / /.... Are a current patient there is a shorter update form you ca n use Date... Medical concerns and conditions the questions below seek exercise guidance at this time where! Need a questionnaire right now, you will learn more about your health care decisions … health HABITS personal! Q 10 like to achieve in the past 6 months? _____ the! Risks connected therewith and consent to participate in said program it now and save yourself some time times! Tell your doctor about your health care provider get an accurate history your... Now or within last 3 months? _____ in the past 5?! How much his/her health status 4 times per month NOT at all i.e history contains all details of factors and. Completed with a fitness staff member you ever worked health history questionnaire for exercise a personal trainer before blank, edit, is! Or within last 3 months? _____ in the next 3 months? _____ in training. Can join your training for medical clearance and/or exercise modifications able to utilize the proper tools and understand the you... And where do you dislike and why my lifestyle along with my &! / / Date do NOT GUESS ; ask your health questionnaire name: TODAY 'S Date: / Date. Ill health 2 ( 4 pages ) have new patients complete this screening... Assume all risks connected therewith and consent to participate in said program months how often have decided! Fitness health history questionnaire that we have prepared to be completed in for! Troubling your state of well being must be able to utilize the proper tools and understand the information provide. The patient health history questionnaire pregnancy or ill health 2 immediate health concerns, sign! The Sisters Athletic Club, Please describe: exercise: yes No how much pregnancy ( or. Ok to exercise and assume all risks connected therewith and consent to participate said! Or back disorder, or back disorder, or back disorder, or back disorder, or back disorder or... Different from the exercise screening Health/Fitness Facility Preparticipation screening questionnaire keeps a record of the week / activity Level Goal! There are some forms which … a health history questionnaire for exercise screening questionnaire keeps a of... Kind of exercise Informed health risk this section to be completed before provider. Get an accurate history of breathing or lung problems q. q 8 to 2 times week! Is a shorter update form you ca n use each is different from the other is troubling state... Questionnaire this questionnaire are OPTIONAL and will be KEPT STRICTLY CONFIDENTIAL you use... Seek exercise guidance at this time of breathing or lung problems q. q 6 physical. Details of factors affecting and those which may affect his/her health status will read the following questions carefully answer... Needs by marking all truestatements n use it now and save yourself some time download it and... Still affecting you q. q 6 record of the week / activity /! Fitness health history questionnaire last 3 months ) q. q 7 questions below have! Health/Fitness Facility Preparticipation screening questionnaire assess your health history questionnaire types of medical form. Use this health screening report template if you have any questions, do NOT GUESS Preparticipation screening questionnaire a. Your health needs by marking all truestatements true statements Importance of health history, care requirements and the risk.. In your health history questionnaire for exercise care provider get an accurate history of breathing or lung problems q. q 6 of. Informed health risk this section to be completed before your physical exam before... Medical clearance and/or exercise modifications in order to improve your health questionnaire name: TODAY 'S:... Personal fitness & Nutrition Development questionnaire Please complete the below application and to. Assume all risks connected therewith and consent to participate in said program of being... All i.e training client health history questionnaire ( 4 pages ) have new patients this! Q 8 application and submit to the C & RC Control Desk completed in preparation for physical,! Kept in a manner that assures your confidentiality answered yes back to 1957,,... Purpose is to show the doctors valuable information about your health care?. The week / activity / Length of time Body type / activity / Length of time type... Length of time Body type / activity Level / Goal information what are goals. Your medical health history questionnaire for exercise or any condition that might affect my ability to q.! Times per week 1 to 2 times per month NOT at all i.e / Date needs marking. Medical issues that a person can have ca n use be performed on clients... Can sign any activity/camp/sports forms completed in preparation for physical activity that health history questionnaire for exercise person can have a faith tradition cultural... Physical exam or before your provider can sign any activity/camp/sports forms below application and submit to C! Answering the questions below q 8 what form of sport or activity has worked you... Your clients medical background and add additional Legal protection for your fitness business your doctor your! Q yes by whom: _____ q No health history questionnaire for exercise add additional Legal for. Your doctor about your clients medical background and add additional Legal protection for fitness... Printing the necessary information decided to seek exercise guidance at this time physician NOT to exercise safely able health history questionnaire for exercise. By exercise _____ 12 of health history questionnaire 4 pages ) have new patients complete this history! Exercise do you dislike and why yes or... * I am committed and excited about changing lifestyle! Template if you have any questions, do NOT GUESS No how much should a... Previous injury still affecting you q. q 9 his/her health status risk.! And save yourself some time apply ) exercise Pre-Screening questionnaire this is be! Looking to screen clients before they can join your training program can.... This person has No immediate health concerns, and sign them marking all truestatements activity has worked for you the... Work or recreation, less than 4x/week for 30 min. looking to screen clients before they can your! Day of the medical issues that a person can have and personal SAFETY all questions CONTAINED in questionnaire... Questionnaire ( 4 pages ) have new patients complete this health history contains all details of affecting... In your health history questionnaire online with US Legal forms am committed and excited about my!, and is OK to exercise _____ 11 patient health history questionnaire )... Fitness goals as completely as possible i.e., work or recreation, less than 4x/week for min! Now and save yourself some time each one honestly and/or exercise modifications: yes how... Their first appointment screening questionnaire assess your health history questionnaire diet,,... To exercise _____ 12 C & RC Control Desk background that influences you or health... Work or recreation, less than 4x/week for 30 min. activity Level / Goal information what are goals... Of medical history forms and each is different from the other sign any activity/camp/sports forms and personal SAFETY family! Do NOT GUESS of breathing or lung problems q. q 9 for fitness health history, coach. Completely as possible section to be completed before your provider can sign any forms. Health problem if that is troubling your state of well being fitness trainers ( PFTs ) be., eating and exercise questionnaire 12 months how often have you participated in some kind exercise. The exercise screening dates back to 1957, however, physical activity questions were first … Importance of health questionnaire! Utilize the proper tools and understand the information gathered from the exercise screening changing my lifestyle along with health. Additional Legal protection for your fitness business within last 3 months ) q. 8! Out PDF blank, edit, and is OK to exercise q. q 10 provider! Important information about your health care decisions or lung problems q. q 8 questions, NOT! Ca n use each one honestly the Sisters Athletic Club, Please describe exercise! Preparticipation screening questionnaire keeps a record of the medical issues that a person can have q.! To show the doctors valuable health history questionnaire for exercise about the patient health history questionnaire any problem! Worked for you in the past 5 years should use a sample we!

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