HEALTH QUESTIONNAIRE | Emma Bowman - Posing & Fitness Coach

HEALTH QUESTIONNAIRE

Please take the time to fill in the answers correctly and provide me with as much information as possible so that I can design a program especially suited to you and your goals. Please note that if you answer YES to any of the medical questions, you will require a medical certificate in order to commence my training program. Please be honest. Your answers are confidential. This information will allow me to help you!

* Please note: There is no need for posing coaching clients to complete the health questionnaire

Your First Name
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Your Date of Birth
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Your Email Address
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Your Occupation
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Your Current Weight
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Your Last Name
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Your Phone Number
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Your Social Media
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Your Height
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Your Goal Weight
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Has anyone in your family under 60 ever suffered Heart Disease, Stroke, Raised Cholesterol or Sudden Death?
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Have you recently undertaken physical training?
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How would you class your current fitness level?
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What time of day do you exercise?
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What exercises do you enjoy most and least?
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Are you on any prescribed medication?
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Have you been hospitalised recently or receiving treatment for any injuries or conditions?
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Are you pregnant, planning on getting pregnant or have recently given birth?
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Do you have or have you had: Heart conditions, Murmurs, Chest pain, Stroke or Angina?
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Low or high blood pressure or disorders?
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Raised cholesterol?
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Do you smoke or have recently quit?
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Diabetes, Epilepsy, Hernia or Gout?
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Dizziness and Fainting?
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Asthma or breathing conditions?
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Stomach or Duodenal ulcers?
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Cancer or any other conditions?
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Do you have or have you had Tendon or Ligament damage, Fractured bones, Back or Neck pain, Join or Muscular pain, Dislocation, Arthritic pain?
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What are your short-term goals?
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What are your long-term goals?
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Is there a part of your body that you are targeting?
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How long have you been training for?
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What does your current program look like?
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How much cardio do you do? What does your cardio consist of?
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How many days per week are you willing to train?
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Are there any exercises you cannot do due to injury or dislike?
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Are you allergic to any foods or is there anything you dislike to eat?
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Foods you like?
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How much water do you drink daily? What other fluids do you drink?
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What supplements do you take?
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Do you have any psychological issues with food or exercise (eg eating disorders)? If so, please explain.
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Is there anything else you would like to tell me about you? Anything else you think I should know?
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