Evaluation Form


    BODY MASTER
    Fitness Studio

    QUESTIONNAIRE

    Client Name:
    Date:
    Age:
    Gender:
    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