January 7, 2018 bestbody Client Assessment Form Client Assessment Form Step 1 of 3 33% Name First Last Email Human PurposeWhat are your Goals?Why do you want to attain this goal?What are your going to gain from the goal?How long do you think the goal will take?MentalRate your overall enjoyment on a scale 1-10, 10 being the most enjoyment:12345678910What is your current occupation?Describe the flow of your average day. When are you at your best? When do you feel your worst?Rate your overall stress level 1-10, 10 being the most stressed12345678910 Organism BodyWhat is your birthdate? ______ / ________ / __________Height: _______’_________Current Body Weight: ___________ lbsList of current or past medical issues: Are you taking any medications, prescription or OTC?List any known allergies to medications or environment: How many times per year are you sick?_____________For women, please describe your menstrual cycleSleepHow many hours of sleep do you get per night? ___________How many times do you wake up per night? ____________Rate your sleep quality on average from 1-10, 10 being the best12345678910NutritionWhere do you normally shop for food?How many bowel movements do you have a day?BodyDo you have problems with gas or bloating?yesnoHave you followed a food program before?yesnoIf so, how compliant were you? Rate on a scale of 1-10, 10 being completely compliant12345678910 Athlete Training HistoryHave you had a history of fitness?yesnoWhat types of fitness have you engaged in?Did you play any sports? At what level? For how long?CAPTCHA Facebook Twitter Instagram Youtube