Body Assessment

• Body Assessment for Studio 99 Client

• Conducted on

  Date

• Prepared by

Client information

• Client Name

• Client phone number

• Client email address

• Occupation

• Address

• What is your preferred method of contact? (Eg. Phone, email, text)

Emergency contact details

• Emergency contact name and relationship

• Emergency contact number

General information

• Age

• Height

• Weight (kilograms)

Health Profile

• Outline your current exercise regime (how many times per week, kind of activity, duration)

• Are you or have recently been pregnant?

• What are your short term goals (9 weeks)

  Select Body fat loss Muscle Gain Strength Production Increase flexibility General health maintenance Other

  • Body fat loss
  • Muscle Gain
  • Strength Production
  • Increase flexibility
  • General health maintenance
  • Other

• Comments

• What are you long term goals? 6+ months

• How active is your job?

  Select Sedentary Somewhat active Active Very active

  • Sedentary
  • Somewhat active
  • Active
  • Very active

• Is it difficult for you to gain weight? Can you eat a lot and still not gain weight

• Do you gain or lose weight according to your fluctuations and food consumption?

• Is it difficult for you to lose weight?

• How aware are you of nutrition and how your body responds?

Nutrition

• List the food, beverages, supplements etc that you take on an average day. (List as breakfast, lunch, dinner and snacks)

• List any food restrictions eg. Allergies, preferences

• Have you consulted a nutritionist in the past? For what reason and did it work for you?

Measurements

• Blood Pressure

• Beats per minute

• Chest (cm)

• Waist (cm)

• Thighs (cm)

Skin fold test (cm)

• Dominant side

• Tricep

• Bicep

• Chest

• Abs

• Hip

• Upper Back

• Lower Back

• Quad

• Calf

Body fat percentage

• Weight in pounds = Body weight (kg) x 2.2

• All numbers added x 27. Divide by body weight in pounds

• BMI

• Body fat percentage

Progress photo

• Progress photo

  Media

Disclaimer and further information

• Please take a moment to carefully read the following information and sign this document.
  This agreement ensures that the role of the trainer to client and client to trainer is clearly appreciated and understood. This agreement must be signed prior to beginning the training sessions.
  
  To keep this program running smoothly, we would like to outline the following client responsibilities
  
  Be on time for sessions with your Personal Trainer. Typically each session is 30-45 minutes; however a more flexible length can be established. The time of sessions is to be agreed upon between the trainer and the client.
  If the client is late, the session will only last until the end of the time that the session was scheduled.
  Any tardiness of more than ten minutes or absence without proper notification will result in the loss of the session.
  If a session needs to be cancelled for any reason other than an emergency, a 12 hour notice must be given to the trainer. Failure to do so will result in the client forfeiting the session and no payment reimbursement will be granted.
  No roll-over sessions or refunds will be granted, except for medical reasons, which must be endorsed by your physician.
  It is recommended that you bring a water bottle (NO GLASS BOTTLES) to every session. It is required that you bring a towel to every session.
  Your Personal Trainer will give personal instructions based on your goals and ability and it is required that you follow these instructions on your own accord.
  If by any stage you wish to cancel your Personal Training sessions, you must notify your Trainer and Manager on the Facility (Peter) via email or written letter with your reasoning.
  No further contact will be made only if required.
  
  If you have any questions feel free to contact Peter on 0402 733 783.
  
  I agree to engaging the services of a personal trainer with Studio 99 Fitness Centre to design a program to aid in, and enhance my fitness goals. I will not hold Studio 99 liable for any problems, illness or injuries that might occur due to a change in my lifestyle. This program and training does not replace the advice of a medical practitioner, registered dietician or any medial provider or treatment. I have revealed any and all necessary information about myself to prevent any possible complications.
  
  

• Client signature

  Sign

• Personal Trainer signature

  Sign