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CLIENT HISTORY - Virtual Home Fitness - Marc D

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CLIENT HISTORY - Virtual Home Fitness - Marc D Powered By Docstoc
					                  virtualhomefitness.com
                     marc@virtualhomefitness.com, 561 676-6179

Name                                              Age
Address                                           Email
Home Phone                                        Cell
Emergency Contact                                 Phone
Breakfast (list foods)
Lunch
Dinner
Goals
Current Exercise
Medication(s)
Surgery(s)
Medical History (Circle and explain any that apply)
Neck                      Fingers                      Ankles
Wrist                     Knees                        Arms
Hips                      Elbow                        Low Back
Shoulders                 Middle Back                  Cramps/Weak
Alcoholism                Fractures/Dislocat’ns        Pacemaker
Allergies/Sinusitis       Heart Attack/Disease         Paralysis
Anemia/Bleeding           Hernia                       Phlebitis
Angina/Chest Pains        High Cholesterol             Pregnancy
Arthritis/FM              High Triglyceride            Rheumatic Fever
Asthma                    History Diabetes             Shortness of Breath
Cancer                    History Heart                Smoked in Past
Cigarette Smoking         Disease                      Sports Injury
Diabetes                  History                      Strains
Digestive Conditions      Hypertension                 Stroke
Dizziness/Blackouts       Hysterectomy                 Thyroid
Emphysema                 Menopause                    Varicose Veins
Epilepsy                  Muscle                       Other
Fainting                  Osteoporosis
Release of Liability +I understand that fitness activities involve a risk of injury. I
understand that there are risks of physical injury as a result of participating in exercise
and physical training activities, and I agree to assume the full risk of and release Marc
Thompson from any liability. +I do hereby further declare myself to be physically sound
and suffering from no condition, impairment, disease, infirmity or other illness that
would prevent my participation of exercises or use of equipment or machinery. +Any
cancellation or postponement within 24 hours of the scheduled sessions will be charged.

Signature                                                            Date

				
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Description: Not for daily exercise, very few people in terms of activity, it is necessary to develop the habit of regular exercise may be difficult, but think of sports, sticky feeling after sweating and sweat smell, that is, people Do not feel comfortable, may be more difficult. It is recommended to have thought that people who lose weight, may wish to start their daily lives "moving. " Drag mopping floors, wiping windows, planting flowers and trees, and so home activities, allows the body to have appropriate activities, but also burns calories and not too tired.