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Client Details |
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Client First Name: |
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Client Surname: |
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Email (required): |
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Client Registration Number (required): |
(this number is given to you once you
have registered for personal advice) |
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Contact Tel: |
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Date of Birth: |
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Height: |
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Weight: |
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Gender: |
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Body Fat%
(if known):
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Occupation: |
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Smoker: |
if yes, how many per day
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Drinker: |
if yes, how many per day
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Medical History |
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Do you suffer from: |
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Heart Disease |
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Asthma |
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Diabetes |
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High Blood Pressure |
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Major Surgery |
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if yes, supply details,
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Other Ailments |
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if yes, supply details,
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Are you on Medication |
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if yes, supply details,
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Exercise History |
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Exercise sessions per week: |
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Exercise duration per session:
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Exercise intensity: |
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Do you do other exercise? If Yes,
please provide details: |
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How long have you been exercising
regularly (months): |
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Do you use a heart monitor when
exercising?: |
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Dietary Habits |
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How many times a day do you eat?: |
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Are you a vegetarian? |
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Do you eat fresh fruit and vegetables
everyday? |
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How many times a week do you eat fast
food?: |
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Aims and Goals |
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What are your aims and goals; |
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Maintain/Reduce Weight |
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Aerobic Exercise |
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General Fitness |
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Reduce Stress |
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Improve Strength |
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Reshape your body |
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which body part,
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Sport Specific |
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which sport,
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Would you like a weekly outline or a
few rowing session ideas? |
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