Name:
City:
Email:
Contact Number:
Age:
Weight:
Eating Habits:
Good
Fair
Poor
Bad
Desired Weight:
PHYSICAL CONDITION
Good Health?
Yes
No
Heart problems?
Yes
No
Asthma?
Yes
No
Diabetic?
Yes
No
High Blood?
Yes
No
Knee injury?
Yes
No
OTHER PROBLEMS THAT MAY HINDER YOUR PERFORMANCE?
WHAT IS YOUR FITNESS GOAL?