FITNESS ASSESSMENT FORM

ALL INFORMATION RECEIVED ON THIS FORM WILL BE TREATED AS STRICTLY CONFIDENTIAL.

Consultation Agreement

I agree to the following conditions for the upcoming consultation with my nutritionist/dietitian:

  • The information I have provided/will provide via questionnaires, phone, email, in-person, or by any other means of communication is accurate to the best of my knowledge.
  • The recommendations I will receive from my nutritionist/dietitian are not a substitute for medical advice from a qualified doctor.
  • The advice I will receive from my nutritionist/dietitian is personal and applies to me only. This same advice may be ineffective or even harmful when applied to other people with different backgrounds.
  • I must communicate to my nutritionist/dietitian any changes in my medical prescriptions or treatments for the duration of my nutrition plan.
  • I must inform my nutritionist/dietitian promptly if any of my new changes in diet or lifestyle start to cause me adverse effects.
  • I understand that the advice I shall receive will not be enough to achieve my nutrition or lifestyle goals unless I follow it diligently and commit to it fully.
  • I understand any changes in my diet and lifestyle may produce effects in my body, energy, health, and condition that are gradual in nature – not instantaneous.
  • I understand that, although my nutritionist/dietitian will endeavor to help me achieve my nutrition and lifestyle goals to the extent possible, the possibility exists I may not fully attain my goals due to factors outside the control of my nutritionist/dietitian.
 

Last updated: never

Joel “JayC” Cruz
Personal Trainer | PN Nutritionist | Fitness Coach. 
 

Assessing Your Needs:

Please fill out the forms as accurately as possible. This information is essential to develop a program that addresses your needs, goals, and interests in a safe and effective manner.

PAR-Q or Physical Activity Readiness Questionnaire

Being physically active is very safe for most people. Some people, however, should check with their doctors before they increase their current level of activity.

The PAR-Q has been designed to identify the small number of adults for whom physical activity may be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.


Answer YES or NO to the following questions:


If you answered NO:

If you answered NO to all the PAR-Q questions, you can be reasonably sure that you can exercise safely and have a low risk of having any medical complications from exercise.
It is still important to start slowing and increase gradually. It may also be helpful to have a fitness assessment with a personal trainer or coach in order to determine where to begin.


When to delay the start of an exercise program:
If you are not feeling well because of a temporary illness, such as a cold or a fever, wait until you feel better to begin exercising.
If you are or may be pregnant, talk with your doctor before you start becoming more active.
Keep in mind, that if your health changes, so that you then answer "YES" to any of the above questions, tell your fitness or health professional, and ask whether you should change your physical activity plan.


Client Fitne​ss Goals (SMART GOALS)

Your goals or aims are what you intend to achieve. Research shows a positive link between people with clearly thought-out goals and their level of success.

In order to increase your chances of being successful at achieving your goals, ensure your goals are “SMART”

S=Specific (provide details, how much, how long, etc)
M=Measurable (how will you measure when you’ve reached your goals)
A=Attainable (be realistic, set smaller goals)
R=Rewards-based (attach a reward to each goal)
T=Time (set specific dates for goals)


Nutrition History & Consultation


Exercise History / Analysis


Lifestyle Analysis


Thank you for filling out the questionnaire. I can use this to compare your progress on the final day of the program.