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