Personal Training Health Questionnaire

Personal training health questionnaire contains relevant health and fitness related questions. This type of questionnaire can be used by an organization, a personal trainer, a health and fitness academy etc. The objective of a personal training health questionnaire is to identify if the participant is fit and enjoys good health and also reveals medical information of the participant as well.

Sample Personal Training Health Questionnaire:

Name of the Participant: _________________________

Gender: ______ (M/F)  |  Age: _____

Address: ______________________________________  City:_______________

State: __________________  Zip: ________________

Email: _____________________________

Phone Number: ____________________________

  • Do you feel that you lead a healthy lifestyle?

a)      Yes

b)      No

c)      I am not sure

  • How often do you make a visit to a doctor in a month due to medical reasons?

a)      Once a month

b)      Once in a fortnight

c)      Once a week

d)     More than once a month

e)      Once in several months

f)       Don’t know

  • Have you ever been diagnosed with any of the following types of heart diseases?

a)      Coronary Heart Disease (CAD)

b)      Atherosclerosis

c)      Variant angina

d)     Mitral stenosis

e)      Atrial fibrillation

f)       Supraventricular tachycardia (SVT)

g)      Hypertensive heart diseases

  • Does your family have a history of heart problems?

a)      Yes

b)      No

  • Is your total cholesterol value over 200 ml/DI? Please provide LDL and HDL value.

a)      Yes

b)      No

c)      LDL: __________________

d)     HDL:__________________

  • Have you ever been diagnosed with diabetes? If yes, then please mention type of diabetes.

a)      Yes

b)      No

c)      Type:______________________

  • Do you use any of the following types of tobacco products?

a)      Cigarettes

b)      Cigars

c)      Dissolvable Tobacco

d)     Electronic Cigarettes

e)      Hookah

f)       Chewable Tobacco

g)      Creamy Snuff

h)      Others: ____________________ (Please Specify)

Category: Training Questionnaire

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