PRE-EXERCISE QUESTIONNAIRE

Anti Clock Health & Fitness Services

Membership no : WeMWC0002
make you back to fit
:15/07/2015
Program

: ANNUAL HEALTH PLAN

Name

: S.SATHISH KUMAR

Phone (O)

(R)

Email ID

Date

Duration : I YEAR End At 15/07/2016

Age

33

Sex MALE

(M) 9445777790

:saisphysio@gmail.com

To help us understand your needs better and tailor your fitness program appropriately ,
please answer the following question with a simple
Is this your first time at a fitness center
YES
Have you been exercising before
If ,yes what type of exercise regime:
cardiovascular training, walking etc
Strength training (weights etc)

YES

YES

Flexibility training

YES

Yoga

NO

Other :

YES
YES
NO

Have you followed any any diet

regime
Is you daily life fairly active

YES

Are you stressed out at the end of the

day

YES

YES

PLAYING CRICKET

Fitness Goal
General fitness and traning

Weight loss

YES

Weight gain

Sports fitness

YES

Rehabilitation
Increase strength

YES
YES

Increase cardiovasculsar capacity

Other :

Do you exercise more than 3

days/week
Have you participate in any sports
activity
Present / Past injury

To serve you better,would you like us to

Provide you with individual fitness
YES
regine
Monitor and change your regime
YES
periodically
Conduct fitness test
YES

Provide you with an individual diet

YES
regime
Provide personal trainer
YES
Contact you when you miss your
YES
training sessions
Leave you alone to train when it suits
you
YES