私教工作表格健康問(wèn)卷

1、健 康 問(wèn) 卷 Health-Check FormIN CASE OF EMERGENCY CONTACT:出現(xiàn)緊急情況需要聯(lián)系的聯(lián)系人：DO YOU NOW OR HAVE YOUHE PAST SUFFERED FROM/HAD THEMEDICIND FOR: 您現(xiàn)在或過(guò)去是否經(jīng)歷過(guò)以下疾/正在服用藥物：YESNOAsthma, bronchitis, breathing difficulties、allergic哮喘、支氣管炎、呼吸、過(guò)敏Migraines, headaches, dizziness偏頭痛、頭痛、頭昏Diabetes/thyroid condition/甲狀腺High

2、blood prere、heartack高血壓、心臟病High cholesterol、high blood fat高膽固醇、高血脂Are you currently taking medication?您最近是否服用過(guò)藥物？Is your doctor know or advice you to do some exercise?您的醫(yī)生是否知道您準(zhǔn)備參與運(yùn)動(dòng)課程或他是否建議您參與？IS THERE ANY FAMILY ILLNESS HISTROY OF家庭成員是否有過(guò)下列病史High blood prere、heartack/stroke/angina高血壓、心臟病/中風(fēng)/心絞痛DO

3、YOU HAVE您是否有過(guò)：Muscular compla s/impairment肌肉疾病/損傷Neck / Back Baist problems頸椎/背部/腰部問(wèn)題Jodisorders/impairment關(guān)節(jié)疾病/損傷Have you feizzyt make you lose your balance or consciousness?您是否有過(guò)頭暈導(dǎo)致失去平衡或失去知覺(jué)？Have you felt your chest pain when you do exercise before?在過(guò)去的一段時(shí)間您在運(yùn)動(dòng)時(shí)胸腔是否有痛楚感？Sport specific injuries特殊運(yùn)

4、動(dòng)受傷Do you smoke?How many cigarettes per day?是否吸煙？每天抽多少支煙？Name：Contact No.聯(lián)絡(luò)：Relationship:與您的關(guān)系：Name：Sex：Date of birth 出生日期：Occupation 職業(yè)：Contact No. 聯(lián)絡(luò)：(Home)：電子郵箱：Date 填寫(xiě)日期：TrainerThe above information should subjectively true, and It is the sole responsibility of ea to inform the instructor of any

5、 changes。ember以上信息應(yīng)客觀屬實(shí)，若有任何的變動(dòng)更改，會(huì)員應(yīng)主動(dòng)告知，這是會(huì)員應(yīng)盡責(zé)任。Do you drink?How many bottles of alcohol do you consume perk.是否喝酒？每周喝多少瓶酒？FITNESS CONDITION健康狀況What physical activities are you currently involved in?您現(xiàn)在從事什么體育運(yùn)動(dòng)？How about exercise ensity?強(qiáng)度如何？Hard medium easy中等 輕松Is there any other causet maybe aff

6、ectedby exercise?是否有其他的原因會(huì)影響到您的?YESNOHave you been exercising regularly for the past three years? (30 minutes-3 to 4 times perk)過(guò)去三年里，您定期做運(yùn)動(dòng)嗎？(每周三次或四次，每次 30 分鐘)YESNONUTRITION CONDITION營(yíng)養(yǎng)狀況YESNODo you have meal on regular basis?您的一日三餐是否規(guī)律?Are you happy with your nutritional knowledge?您在營(yíng)養(yǎng)學(xué)方面的知識(shí)是否豐富？M

7、IND AND BODY心理和身體Do you relax easily and sleep well?平時(shí)您是否容易放松，睡眠質(zhì)量如何？WORKOUT AND EXERCISE GOALS?(1= Very Important) (2= SO-SO) (3= NO NEED)您進(jìn)行鍛煉的目標(biāo)？ (1 = 非常重要) （2 = 一般） （3 = 沒(méi)必要）123Reduce body fat and increase strength減少體內(nèi)脂肪增加力量Body shaand improve flexibility塑造體型增強(qiáng)靈活度Increase muscular endurance & st

8、rength取得總體健美，獲得一些明顯的肌肉塊Improve moods and release prere改善心情，減輕壓力Improve cardiovascular system (Heart/g function)提高心系統(tǒng)(心/肺功能)Helbody recover from injury受傷及促進(jìn)復(fù)元Do you think it will promote your current working and daily life much better to achieve or meet your life goals?您覺(jué)得達(dá)到這些目標(biāo)對(duì)您的工作和生活有何積極意義？What time will you arrange for your workout?您尋找什么樣的時(shí)間范圍來(lái)運(yùn)動(dòng)或鍛煉？How many times you can do your workout in ak?您一周可以接受幾次？Do you want us pro