私教工作表格健康问卷

1、健 康 问 卷 Health-Check FormIN CASE OF EMERGENCY CONTACT:出现紧急情况需要联系的联系人：DO YOU NOW OR HAVE YOUHE PAST SUFFERED FROM/HAD THEMEDICIND FOR: 您现在或过去是否经历过以下疾/正在服用药物：YESNOAsthma, bronchitis, breathing difficulties、allergic哮喘、支气管炎、呼吸、过敏Migraines, headaches, dizziness偏头痛、头痛、头昏Diabetes/thyroid condition/甲状腺High

2、blood prere、heartack高血压、心脏病High cholesterol、high blood fat高胆固醇、高血脂Are you currently taking medication?您最近是否服用过药物？Is your doctor know or advice you to do some exercise?您的医生是否知道您准备参与运动课程或他是否建议您参与？IS THERE ANY FAMILY ILLNESS HISTROY OF家庭成员是否有过下列病史High blood prere、heartack/stroke/angina高血压、心脏病/中风/心绞痛DO

3、YOU HAVE您是否有过：Muscular compla s/impairment肌肉疾病/损伤Neck / Back Baist problems颈椎/背部/腰部问题Jodisorders/impairment关节疾病/损伤Have you feizzyt make you lose your balance or consciousness?您是否有过头晕导致失去平衡或失去知觉？Have you felt your chest pain when you do exercise before?在过去的一段时间您在运动时胸腔是否有痛楚感？Sport specific injuries特殊运

4、动受伤Do you smoke?How many cigarettes per day?是否吸烟？每天抽多少支烟？Name：Contact No.联络：Relationship:与您的关系：Name：Sex：Date of birth 出生日期：Occupation 职业：Contact No. 联络：(Home)：电子邮箱：Date 填写日期：TrainerThe above information should subjectively true, and It is the sole responsibility of ea to inform the instructor of any

5、 changes。ember以上信息应客观属实，若有任何的变动更改，会员应主动告知，这是会员应尽责任。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健康状况What physical activities are you currently involved in?您现在从事什么体育运动？How about exercise ensity?强度如何？Hard medium easy中等 轻松Is there any other causet maybe aff

6、ectedby exercise?是否有其他的原因会影响到您的?YESNOHave you been exercising regularly for the past three years? (30 minutes-3 to 4 times perk)过去三年里，您定期做运动吗？(每周三次或四次，每次 30 分钟)YESNONUTRITION CONDITION营养状况YESNODo you have meal on regular basis?您的一日三餐是否规律?Are you happy with your nutritional knowledge?您在营养学方面的知识是否丰富？M

7、IND AND BODY心理和身体Do you relax easily and sleep well?平时您是否容易放松，睡眠质量如何？WORKOUT AND EXERCISE GOALS?(1= Very Important) (2= SO-SO) (3= NO NEED)您进行锻炼的目标？ (1 = 非常重要) （2 = 一般） （3 = 没必要）123Reduce body fat and increase strength减少体内脂肪增加力量Body shaand improve flexibility塑造体型增强灵活度Increase muscular endurance & st

8、rength取得总体健美，获得一些明显的肌肉块Improve moods and release prere改善心情，减轻压力Improve cardiovascular system (Heart/g function)提高心系统(心/肺功能)Helbody recover from injury受伤及促进复元Do you think it will promote your current working and daily life much better to achieve or meet your life goals?您觉得达到这些目标对您的工作和生活有何积极意义？What time will you arrange for your workout?您寻找什么样的时间范围来运动或锻炼？How many times you can do your workout in ak?您一周可以接受几次？Do you want us pro