client Record Client Record Client Information First Name * First Last * Last Email * Client Start Date Gender MaleFemale Height Weight Date Of Birth Age Occupation Pre-existing medical conditions * Diabetes Heart disease Chest pains Shortness of breath Broken bones Allergies Heart murmur Pneumonia Epilepsy Tachycardia Oedema Heart attack Recent surgery Palpitations High blood pressure Low blood pressure Asthma Seizures Fainting Additional Medical Notes Family History Surgical History Any past surgeries? Health Goals * List in order of importance. Do you currently excersise? YesNo How Often Do You Excercise? What Types Of Exercise? Is there anything that will get in the way of you achieving your results? Level of commitment to improving your health 1 2 3 4 5 1 = Lowest 5= Highest Are you open to weight/resistance training? YesNo Submit Δ
