Health History questionnaire for Personal Training

A health history questionnaire for personal training refers to method to analyze the health conditions of the prospective personal trainees. This questionnaire helps the personal training organizers to have an idea as to how to train a particular individual in a specific way keeping in mind his physical condition. Such questionnaires are generally used by the gym instructors.

Sample Health History questionnaire for Personnel Training

Name: ______________________________________________

Address: ____________________________________________

Phone number: _______________________________________

Email address: ________________________________________

(Please tick in front of the right options wherever provided with choices)

1. Have you been critically ill in the past?

a. Yes

b. No

2. If yes, please specify the details of the illness ___________________________________

3. Do you feel pain in your joints or bones while doing any physical activity?

a. Yes

b. No

4. Do you lose your balance or fall unconscious because of dizziness?

a. Yes

b. No

5. Have you had or presently suffer from any of the following medical situations?

a. High blood pressure

b. Low blood pressure

c. Diabetes

d. High cholesterol

e. Chest pains

f. Pain, discomfort in the chest, neck jaw, arms, or other areas

g. Unusual fatigue or shortness of breath with usual activities

h. Others

6. Please specify other _______________________________________________________

7. Are you on medication for any minor or major health issues?

a. Yes

b. No

8. Do you have history of health problems in your family?

a. Yes

b. No

9. If yes, then give details ____________________________________________________

10. Please provide your following details

a. Height-

b. Weight-

11. Please list down your personal health and fitness objectives.


Category: Training Questionnaire

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