HEALTH STATUS & HEALTH HISTORY

  • (ACSM HEALTH SCREEN)

  • Medical History

  • FAMILY HISTORY

  • MEDICATIONS

  • LIFESTYLE

  • OTHER HEALTH HISTORY INFORMATION

  • HEALTH AND FITNESS GOALS

  • Pleasee tell us a little about your exercise patterns and goals:

  • I verify that all of the completed information is correct to the best of my knowledge. I declare that I am participating voluntarily in a performance fitness test. The maximum exertion during the test is at my discretion and I understand that I can stop the test at any time. I declare that I have no medical problems that prevent me from undertaking the fitness test and that I am not currently taking any medication that could present a danger with the performance fitness test.