Full Name
Age:
Contact Phone:
Experience sports, what kind of?
Where will engage?
What kind of equipment you have and what you can buy (sports equipment)
If you want to train at home, tell us about the circumstances, whether there is a place at what time I want to, and whether you will interfere with anyone else?
If in the Gym then I need to know there are some trainers machine
Wishes that you feel you need to fix it, and what you think you have flaws?
From heart problems? yesno
From back problems? yesno
From asthma? yesno
From gallstones or kidney stones? yesno
From diabetes saharennym? yesno
From any source of bleeding(nose, stomach, hemorrhoids, etc.)? yesno
You are raising or lowering blood pressure? yesno
There are chest pain? yesno
There are heart attacks or interruptions in the heart? yesno
Do you feel shortness of breath and rapid walking or climbing stairs? yesno
There you have swelling in the legs in the evening? yesno
Oncologist? yesno
Psychiatrist? yesno
Do you have thyroid disease? yesno
List than rooting for the past year, all possible infections, viral infections, surgery, injuries and more yesno
Have you ever had a head injury with loss of consciousness? yesno
Do you suffer from chronic kidney disease? yesno
Radiculitis? yesno
Varicose veins? yesno
There you have fainting? yesno
Dizziness? yesno
Have you had in the last year childbirth? yesno
Whether there were complications related to childbirth? yesno
Do you come climax? yesno
Do you suffer from gynecological diseases? yesno
Whether there are failures in menstruation? yesno
Your work is mostly sedentary? yesno
Smoking Do? yesno
Whether there were your parents such diseases (myocardial infarction, hypertension, diabetes mellitus) yesno
Do you suffer from insomnia? yesno
Did you ever have an increased heart rate, on the red faces when communicating with strangers and unusual situation? yesno
Whether there is that your mood changes dramatically throughout the day? yesno
There you have outbursts of anger? yesno
Do you have concerns about the state of health? yesno
Do you feel dissatisfaction with themselves, their actions and deeds? yesno
Resting blood pressure (digits)
Heart rate at rest (figures)
I need to you within seven days of the commencement of the work carried food diary. Every day, write down everything that you eat, detail, indicating the weight and time (example: if a sandwich, then some bread, sausage and fat content of butter and, accordingly, at least approximate weight, if coffee is how many spoons of coffee and how much sugar and so on) more fully and accurately you describe your diet for a week, the better I can help you.
Please describe your work (weekday) and not working (output) day, fully, in detail, by the hour. When you get up, eat, work, what do you do during the day. What is your job (only mental labor, physical, and so on).
Date of commencement of work age:
Weight:
Height:
Neck:
Chest:
Biceps:
Waist:
Buttocks:
Left Thigh:
Right Thigh:
Calfs:
