The form helps the doctor review the health pattern of a patient over a period. Address:!_____! Have you ever had heart trouble or coronary disease? Title: Health History Questionnaire Author: MEM308-1 Created Date: 10/30/2014 12:18:59 PM This is often done through a physical activity readiness questionnaire or PAR-Q. Download. The Practice provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). lIfestYle AnD heAlth- hIstorY QUestIonnAIre Note: HDL = High-density lipoprotein; LDL = Low-density lipoprotein; TG = Triglycerides Continued on next page ©2014 American Council on Exercise¨ 12. A personal training assessment is a tool for that purpose. (please circle) Beginner Intermediate Advanced 2. Learn More. Get a Medical History. UNIT 5 Training for Personal Fitness Medical history questionnaire Before taking part in a training programme every person should carry out some kind of health screening process. Personal Trainer Forms. It generally begins with the basic identity details of the person. If so please explain: 2. 2. I will notify the program staff of any changes in my health. An important part of … Insight about assessments for cardiovascular endurance, muscle strength and endurance, flexibility and body composition can be obtained from the ACSM's resource materials. Every aspect relating to the training process is analyzed through each question. To develop a training assessment questionnaire, you can base your questions on the following categories: Training. If yes, please explain: 3. Forms included are par-q, questionnaires, and assessment sheets. Yes No How long have you been on the diet?_____ 13. Do you have a family history of heart problems or coronary disease? Consultation or screening form (includes health screen, exercise readiness assessment, goal setting sections) A form that allows you to record for the client their exact situation and ideal situation, and then layout a sensible pathway between those two points. Health history questionnaire (online) Have your patients fill out this questionnaire template online prior to their first appointment. equipment during a training session, will not be held liable to my personal trainer. Personal)Information)) Full!Name:!_____! I understand that completion of the Health History Questionnaire is required prior to my participation in a Personal Training Program. Personal Training – HHQ Form – 10/2017 2 MEDICAL HISTORY Please read the 7 questions below carefully and answer each one honestly: check YES or NO YES NO 1. While any educational program goes to start out, the client’s health info has to be acknowledged. Major Risk Factor Identification. The health history form covers all the major health information of the individual filling the form. Please note that all information provided below will be kept confidentially unless allowed or required by law. Dec 5, 2018 - Image result for health history questionnaire for personal training I understand that I need to inform my personal trainer of any prolonged discomfort or unusual symptoms immediately. Whether they enjoyed the training, their personal statements on how the trainer handles the whole training or if the training was appropriate for them. Please provide name and phone number of your doctor: 5. ____ I understand that if my health changes, I will notify my trainer and complete a new health history form. Read this statement prior to signing it. This health screening form is for physical training centers that accept registration from individuals that would want to undergo a series of training related to physical wellness. Note : Males above 44 years old, females above 54 years old, or those considered high risk are required to obtain a physician’s clearance prior to beginning the Personal Training sessions. PDF; Size: 204.6 KB. How to Become a 24 Hour Fitness Personal Trainer.