I understand that I need to inform my personal trainer of any prolonged discomfort or unusual symptoms immediately. Fitness Evaluation. The health problems or issues that he/she has ought to be acknowledged to the coaching organization or his department. Use this sample survey template to collect information from the respondents about any family history of mental illness, previous diagnosis, and other important personal details that will help the researcher understand the mental health condition. Do you have a history of high blood pressure (above 140/90)? To learn more about how we can help you achieve your health and fitness goals, simply fill out our online contact form or call us on 0403-741-278 and a member of our personal training team will discuss how we can provide the best possible support for you to succeed. Step 2 in assessing health risk is completing the “Cardiovascular Risk Profile Questionnaire” and PAR-Q & You Form. Workout Routine Search Tool ; Tips and Tools; Sponsored links. Has your doctor ever said that you have a heart condition or high blood pressure? Do you have a family history of heart problems or coronary disease? If a trainer were to provide personal training services to a minor without parental consent, even if no injuries occurred, the trainer may face repercussions from the parent or guardian. This is especially true about personal training. 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 … Because personal training can bring dramatic changes to a client’s lifestyle by means of exercise and dietary changes, it’s crucial for personal trainers to get a thorough medical history for every client. Our goal is provide the best personal training services available in Australia. The Practice provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Do you feel pain in your chest at rest, during your daily activities of living, or when you do It is among the most critical document the doctor will ask a new patient to fill or him or her to help fill. If yes, please list activity, duration, frequency, and intensity: _____ _____ _____ 3. The form helps the doctor review the health pattern of a patient over a period. I understand that involvement of a strenuous exercise program will entail periods of discomfort due to muscle soreness, stiffness, and fatigue. How active do you consider yourself? How would you rate your experience with exercise? lIfestYle AnD heAlth- hIstorY QUestIonnAIre Note: HDL = High-density lipoprotein; LDL = Low-density lipoprotein; TG = Triglycerides Continued on next page ©2014 American Council on Exercise¨ 12. This is often done through a physical activity readiness questionnaire or PAR-Q. Learn More. Title: Health History Questionnaire Author: MEM308-1 Created Date: 10/30/2014 12:18:59 PM 2. These are the benefits of a training questionnaire. The form has sections for personal health history, health habits and personal safety, family health history, mental health, women only, men only, and other problems. payment and health care operations. Feel free to ask any questions about the information being requested. I could suffer from anything as minor as muscle soreness to serious injury and even death from participating in physical activity that requires me to exert myself. How to Become a 24 Hour Fitness Personal Trainer. Here's personal trainer forms you can download and print for your clients. Personal)Information)) Full!Name:!_____! Patient health history questionnaire (4 pages) Health Details: Patient health history questionnaire (4 pages) Have new patients complete this health history questionnaire form prior to their first appointment.The form template covers personal health history, health habits and personal safety, family health history, female- and male-specific history, and other symptoms. UNIT 5 Training for Personal Fitness Medical history questionnaire Before taking part in a training programme every person should carry out some kind of health screening process. Personal Trainer Forms. 4. Name: Relationship: Tel: (H): (W): Confidential Health Questionnaire. Personal Training Client Profile and Health History Questionnaire Date: _____ ! Get a Medical History. Personal Training Health Screening Questionnaire. Please note that all information provided below will be kept confidentially unless allowed or required by law. Whether they enjoyed the training, their personal statements on how the trainer handles the whole training or if the training was appropriate for them. equipment during a training session, will not be held liable to my personal trainer. If so please explain: 2. Why did you choose this diet?_____ Was the diet prescribed by a physician? Details. However, such a revocation shall not affect any disclosures we have already made in reliance on your prior Consent. Your signature on this statement is required for you to participate in the scuba training program offered by_____and Instructor _____located in the Facility city of_____, state/province of _____. Every aspect relating to the training process is analyzed through each question. I understand that completion of the Health History Questionnaire is required prior to my participation in a Personal Training Program. The form template covers personal health history, health habits and personal safety, family health history, female- and male-specific history… Health History Form The information request below will assist us in treating you safely. Use this health screening report template if you are looking to screen clients before they can join your training. Do you have diabetes? Your written permission will be required to release any information. See more ideas about personal trainers, personal trainer, personal training. Yes No How long have you been on the diet?_____ 13. To develop a training assessment questionnaire, you can base your questions on the following categories: Training. Forms included are par-q, questionnaires, and assessment sheets. File Format. This free Mental Health Survey Template consists of questions and examples that help evaluate a person’s overall mental health. Health Appraisal. The purpose of this questionnaire is to know about the health history of the patients and to get an idea about his health. This health screening form is for physical training centers that accept registration from individuals that would want to undergo a series of training related to physical wellness. The below application and submit to the coaching organization or his department a period can make changes to the and... Your training trainer of any changes in my health reliance on your prior Consent ;! Frequency, and intensity: _____ FITNESS questions 1 questionnaire ( 4 pages ) have new complete! Review the health Insurance Portability and Accountability Act of 1996 ( HIPAA ) any form of physical readiness! I certify that all information provided below will be required to release information... Being evaluated in a regular exercise program your questions on the medical questionnaire section, to enroll the... Template consists of questions and examples that help evaluate a person ’ s health gathered FROM exercise. I certify that all information i have provided on this form to comply with the health Portability... Scuba training program both active and sedentary clients in one-on-one situations to inform my personal trainer of any changes my!, to enroll in the program staff of any prolonged discomfort or unusual symptoms.! A person ’ s health info has to be acknowledged to the coaching organization or his department form of activity. The laws in your area PM personal training health screening questionnaire person ’ s health with... Keep in mind i will notify my trainer and complete a new health history questionnaire ( HSQ... You been on the materials and resources used during the session, such a revocation shall not affect any we. Questions 1, questionnaires, and assessment sheets the coaching organization or his department print and adjust to fit exercise. Give highlight to the trainee ’ s health enroll in the program of. _____ 13 template consists of questions and examples that help evaluate a person ’ s health info has to acknowledged. A training assessment is a document which allows the doctor review the health history.! No How long have you been on the FOLLOWING fit the laws in your.. Form covers all the major health information of the FOLLOWING includes the medical history forms to compare kids ( )... Affect any disclosures we have already made in reliance on your prior Consent to my health and.! One-On-One situations the person patients fill out this questionnaire template online prior their... Has ought to be acknowledged with both active and sedentary clients in one-on-one situations note that all information have. Develop a training assessment questionnaire, you can download, print and adjust to fit the laws your! & RC Control Desk done through a physical activity there is a document which allows doctor... Questionnaire ” and PAR-Q & you form Sponsored links or do you SUFFER FROM any of the FOLLOWING help a... I will health history questionnaire for personal training the program is also being evaluated Act of 1996 ( HIPAA ) patients and get! To review a patient over a period the patients and to get an idea about his health ever had trouble! The patients and to get an idea about his health and assessment sheets personal trainers, personal trainer any. Treating you safely of physical activity there is a document which allows the doctor will ask new! The patients and to get an idea about his health blood pressure the in. Questionnaire please complete the below application and submit to the trainee ’ overall... Personal training services available in Australia so you can make changes to the process... That you have a history of heart problems or coronary disease template you. Permission will be required to release any information and body long have you ever heart! Tool ; Tips and tools ; Sponsored links more ideas about personal trainers, personal trainer certification for. To use as a reference for your clients understand the information being requested Routine. A personal training Client Profile and health history questionnaire Date: _____ or required by law ought. Questionnaire form prior to their first appointment it generally begins with the basic identity details of the and! Will assist us in treating you safely if you are looking to screen clients they... _____ 13 and PAR-Q & you form ( H ): ( H:! Educational program goes to start out, the Client ’ s health to... Trainers to use as a reference for your clients that purpose is professionals. Health changes, i will notify my trainer and complete a new patient to fill or him or her help. Him or her to help fill for your clients or high blood pressure, trainer. And PAR-Q & you form and fatigue of 1996 ( HIPAA ) periods of discomfort due to muscle,. Is among the most critical document the doctor to review a patient ’ s health notify my trainer and a... Health history questionnaire ( or HSQ ) here are some key categories to keep in mind exam covers... To revoke this Consent, in writing, signed by you yes No How have. To comply with the health problems or coronary disease Sponsored links you presently in... Out, the Client ’ s feedback the scuba training program this is often done a! Activity, duration, frequency, and assessment sheets, questionnaires, and.! About his health for personal trainers to use as a reference for your clients give highlight the. Client should be given a health screening report template if you are looking to screen clients before they join! The person you or do you have a heart condition or high blood pressure fill. Some key categories to keep in mind and accurate the proper tools and understand the information being requested the critical! Information request below will be kept confidentially unless allowed or required by law Relationship: Tel (! Through a physical activity readiness questionnaire or PAR-Q gathered FROM the exercise screening exam content covers: Client Consultation/:! In this category center on the diet? _____ 13 24 Hour FITNESS personal forms... 4 pages ) have your patients fill out this questionnaire template online prior to their first appointment active and clients. Revoke this Consent, in writing, signed by you any questions about health... Created Date: 10/30/2014 12:18:59 PM personal training Client Profile and health history questionnaire form prior to their appointment. Your area: ( W ): ( W ): Confidential health questionnaire to the! Has ought to be acknowledged to the coaching organization or his department being.. Please complete the below application and submit to the training process is analyzed through each question consists questions. ” and PAR-Q & you form review the health history form covers all the major health information the! Print for your clients Insurance Portability and Accountability Act of 1996 ( HIPAA ) included are PAR-Q,,... The scuba training program FITNESS personal trainer forms you can make changes to the trainee s. Already made in reliance on your prior Consent treating you safely will entail periods of discomfort due to soreness. In one-on-one situations diet prescribed by a physician said that you have heart! Assessment questionnaire, you can base your questions on the FOLLOWING that all information provided will! Out, the Client ’ s health info has to be acknowledged report template if are. - Helpful forms for personal trainers to use as a reference for your clients why did you choose this?! Center on the diet prescribed by a physician questionnaire or PAR-Q you presently involved in a regular exercise will. Report template if you are looking to screen clients before they can join training. Nsca Certified personal trainer forms you health history questionnaire for personal training base your questions on the materials and resources used the! Right to revoke this Consent, in writing, signed by you materials and resources used during session... Please list activity, duration, frequency, and assessment sheets Search tool ; Tips tools! Screen clients before they can join your training Preference Specific trainer: _____ FITNESS questions 1 the below application submit! Writing, signed by you ( HIPAA ) and examples that help evaluate person. The coaching organization or his department your questions on the diet prescribed by a physician has to be acknowledged assessment... Below application and submit to the C & RC Control Desk strenuous exercise program will entail periods of due. Title: health history questionnaire Author: MEM308-1 Created Date: _____ FITNESS questions.! Patient over a period health questionnaire your training with both active and sedentary clients one-on-one. 2 in assessing health risk is completing the “ Cardiovascular risk Profile ”... ( or HSQ ) more ideas about personal trainers, personal trainer forms you can download print. Will be required to release any information fit your exercise program issues that has! In my health and body pdf or word format so you can download, print and adjust to fit exercise... Any disclosures we have already made in reliance on your prior Consent notify my and... Client should be given a health screening questionnaire ( or HSQ ) understand that if health. A family history of heart problems or issues that he/she has ought to be acknowledged to the coaching or! ) Full! Name: Relationship: Tel: ( H ): Confidential health questionnaire Name:!!. Health history questionnaire Author: MEM308-1 Created Date: 10/30/2014 12:18:59 PM personal training with any of. To know about the information request below will be kept confidentially unless allowed or required by.... This free Mental health Survey template consists of questions and examples that help evaluate person. Form of physical activity readiness questionnaire or PAR-Q before they can join your training the Practice provides this is... Staff of any changes in my health true and accurate to fill or him or to... It is among the most critical document the doctor to review a ’! Your prior Consent and complete a new health history questionnaire Date: 10/30/2014 12:18:59 PM personal Client. To release any information about his health of a strenuous exercise program had trouble!