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Fitness Assessment Guide

Name: Date:
Email Address: Phone:

Height: Weight: Body Fat%:

GOALS:
1._________________________________________________________________

2._________________________________________________________________

3._________________________________________________________________

REALITY
How often do you have your blood work screened at your doctor’s?_____________________________________
Do you have family history of: Heart Disease Diabetes High Cholesterol
Hypertension Cancer

Exercise
History:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Nutrition Habits:
# of Meals/Day:____________
Breakfast:_____________________________________________________________________________________
Snack:________________________________________________________________________________________
Lunch:________________________________________________________________________________________
Snack:________________________________________________________________________________________
Dinner:_______________________________________________________________________________________
Snack:________________________________________________________________________________________
Vitamins/Supplements:__________________________________________________________________________

Injuries or
Limitations:____________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Obstacles or
Challenges:____________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

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