Personal Information

  • Date of Assessment

  • Client Address
  • Date of Birth

  • Email Address

  • Best Contact Number

  • How did you hear about My Ultimate Me?

Lifestyle & Fitness

  • What is your Fitness Goal?

  • Explain the specifics around your fitness goal?

  • How soon would you like to achieve this?

  • Do you think that lifestyle changes will help achieve your goals?

  • How much time (in minutes) can you allow for exercise per day?

  • How much time (in minutes) can you allow for exercise per week?

  • What is the best time for you to exercise?

  • How do you prefer to exercise?

Medical Assessment

  • Do you have any pre-existing medical conditions that would limit your ability to exercise?

  • Do you have any specific issues with joints mobility, bones or muscles that we may improve with exercise?

  • Are you currently seeing your doctor about any condition that may be affected by exercise? Gives details if yes?

  • Detail and current medicines, pills, tablets or natural supplements you are taking currently?

Physical Activity & Nutrition

  • Detail any exercise you are doing at the moment?

  • What types of exercise do you enjoy the most?

  • Any other exercise?

  • What types of exercise do you not enjoy?

  • How many meals do you eat each day?

  • How big are the portions normally?

  • How many glasses (250ml) of water do you drink each day?

  • What foods do you like the most?

  • Would you like to change you eating habits and parts of your lifestyle to assist with reaching your goals?

  • Would you like a referral to a nutritionist?

Basic Metrics

  • Resting Heart Rate BPM

  • Chest measurement (in cm)

  • Hip measurement (in cm)

  • Waist measurement (in cm)

  • Height (in cm)

  • Weight (in KG)

  • BMI - Body Mass Index

  • Overweight range BMI

  • Obese range BMI

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