Evaluation Form BODY MASTER Fitness Studio QUESTIONNAIRE Client Name: Date: Age: Gender: MaleFemale Height: Resting Heart Rate: PRE-EXERCISE EVALUATION Date Heart Rate Blood Pressure BODY COMPOSITION EVALUATION Bio-Impedance Date Weight Lbs Body Fat Lbs Lean Mass % Body Fat 7 Site Evaluation Date Tricep Pectoral Subscapular Axillary Suprailiam Abdominal Thigh Total % Body Fat Circumference Evaluation Date Neck Shoulders Chest Waist Hips Thigh (Left/Right) Calf (Left/Right) Upper Arm (Left/Right) CARDIORESPIRATORY EVALUATION 3 Minute Step Test Date Heart Rate Rating FLEXIBILITY EVALUATION Sit & Reach Test Date Inches Rating General Flexibility [1=100% 2=75% 3=50-75% 4<50%] Date Hamstrings (Left/Right) Hip Flexors (Left/Right) Gluteals (Left/Right) Calves (Left/Right) Quadriceps (Left/Right) Lower Back Abdominals Neck Shoulders (Left/Right) Pectorals(Left/Right) STRENGTH & ENDURANCE EVALUATION Date Push-Ups (60 beat) Reps Rating Bench Press (60 beat) Reps Rating Crunches (1 minute) Reps Rating COMMENTS/NOTES