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Client Screening Form *
FITNESS TRAINER Date
Client details
Client’s Name * Gender * Height* Weight* Age*
Any health risk factors? Ensure the client also completes the PAR-Q
Client Medical history *
None
Client’s Medications
Lifestyle Evaluation *
Occupation
Time availability on a
weekly basis
General Lifestyle
summary (diet,
sleep, habits)
Current Fitness Profile *

Physical activity levels:
LOW/MEDIUM/HIGH
Exercise and training history

Exercise contraindications
Client’s Exercise preference *
Likes Dislikes
Client’s barriers to exercise

Barriers to exercising and achieving goals including
motivational barriers Strategies to overcome them
SPECIFIC GOAL
Specific fitness goals

Create a short, medium and long term SMART goal that could be applied to a client in a fitness setting.
Short Term (4-6 weeks) Medium Term (8-12 weeks) Long term (6 months plus)
Other information
Informed consent completed YES NO
Clearance letter from a health professional or physician if needed YES NO
Physical Activity Readiness Questionnaire (PAR-Q)*

Client’s Name Date
Taking part in physical activity/exercise is very safe for most people. However, some people should check with their
doctor before they start an exercise session. Before taking part in physical activity and/or exercise, please answer the
questions below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor
before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer
each one honestly: please select YES or NO.
1. Has your doctor ever said that you have a heart condition and that you should only do physical
activity/exercise recommended by a doctor?
2. Is there any history of heart disease in your family?
3. Do you feel pain in your chest when you do physical activity/exercise?
4. In the past month, have you had chest pain when you were not doing physical
activity/exercise?
5. Do you lose your balance because of dizziness or do you ever lose consciousness?
6. Do you have a bone or joint problem (for example, back, knee or hip) that could be made
worse by a change in your physical activity? (if so, please give details)
7. Do you suffer from any of the following: asthma; diabetes; epilepsy; high blood pressure? (if
so, please give details)
8. Do you have any other medical or physical condition (such as diabetes, cancer, osteoporosis)?
9. Do you have any current injuries or conditions, and if so, are they being treated by a doctor or
other health professional such as a physiotherapist? (if so, please give details)
10. Do you know of any other reason why you should not do physical activity/ exercise?
If you answered YES to any of the questions above, please check with a member of staff before taking part in the
physical activity or exercise session. It may be necessary for you to be referred to your doctor before taking part in the
session.
If you answered NO to all questions, you can be reasonably sure that you can safely take part in the physical activity
or exercise sessions, but please ensure that you begin slowly, warm up appropriately and progress slowly.
Assumption of Risk: I declare that I have read, understood, and answered honestly all the questions above. I am
agreeing to participate in the exercise session (which may include aerobic, resistance, power and stretching exercises)
and understand that there may be risks associated with physical activity.
I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.
Client’s Signature Date
Informed Consent Form
General statement
I understand that this physical fitness programme includes exercises to build the cardiorespiratory system (heart and
lungs), the musculoskeletal system (muscles, joints and bones) and to improve body composition.
Exercise may include aerobic activities such as treadmill, running, walking, bike, rowing, group aerobic activities,
weight training and exercises for mobility and flexibility.
I understand that it is my responsibility to inform the instructor of any health problems, injuries, pregnancy’s or recent
pregnancies or any other health conditions that is relevant to me exercising.
In the event that medical clearance must be obtained prior to my participation in the exercise programme, I agree to
consult my physician and obtain written permission from my physician prior to the commencement of any exercise
programme.
I understand that I am responsible for monitoring my own condition throughout any exercise programme. Should any
unusual symptoms occur I will stop my participation and inform my instructor of the symptoms immediately. I also
understand that I may discontinue the sessions at any time due to adverse symptoms and that I should inform my
instructor accordingly.
In signing the consent form I affirm that I have read this form in its entirety and that I understand the nature of the
practical exercise sessions. I also confirm that my questions regarding the exercise programme have been answered
to my satisfaction.
Instructor’s
Name
Client’s Name
Client’s
Signature
Date
Initial Assessment
Client’s Name
Instructor’s Name
Date
Physical Measurements and Fitness Assessments Record

Assessment Results/Observations Give a reason for choice of
(circle chosen test – minimum of test
three) If these tests were not carried out,
please explain/justify your reason
Blood pressure
• Manual
• Digital
Anthropometrics
• BMI
• Waist circumference
Body composition
• Skinfolds callipers
• Bio-electrical impedance
Muscular strength and
endurance
• Sit-up
• Press up
• Squat
Cardiovascular fitness
• Bike treadmill
• GTS
Specific range of movement

(ROM)
• Soleus and gastrocnemius
• Hamstrings
• Quadriceps and hip flexors
• Pectoralis major
• Latissimus dorsi
Posture and Alignment
observation
• Head
• Shoulders
• Pelvis and lumbar spine
• Knees
• Feet and ankles
CLIENT NAME
AGE
RHR
MHR
HRR
WARMUP
50%
60%
MUSCULAR
ENDURANCE
60%
70%
FAT LOSS
70%
80%
HITS
80%
90%
Transformation Route
HEIGHT : WEIGHT : BMI :

HEALTHY BMI RANGE: IBM :
LEAN BODY MASS = KG
BODY FAT % = % TARGET % = REDUCTION =
ACHIEVABLE WEIGHT LOSS = WEEKS NEEDED =
LOSS PER WEEK = REDUCTION CALORIE =
WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 WEEK 6
WEEK 7 WEEK 8 WEEK 9 WEEK 10 WEEK 11 WEEK 12
WEEK 13 WEEK 14 WEEK 15

Maintain Weight
Weight Loss
QUESTIONNAIRE
1. Do you have any allergies?

2. Do you have any cultural food preference?
3. Which foods you like and dislike?
4. How much time do you spend cooking?
5. What is your weekly food budget?
W
SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
PROGRAMME DESIGN FOR WEEK 1 TO 5
Name of the Timings/repetitions Equipment Approach/training THR

exercise method
Warm up phase
Joint
Mobilisation
Dynamic
stretching
Heart rate
elevation
Main phase
Cool down
phase

exercise method
Warm up phase
Joint
Mobilisation
Dynamic
stretching
Heart rate
elevation
Main phase
Cool down
phase

exercise method
Warm up phase
Joint
Mobilisation
Dynamic
stretching
Heart rate
elevation
Main phase
Cool down
phase
Assessment Initial Results post 6 week results
Body weight
Blood pressure
Anthropometrics
● BMI
● waist circumference
Muscular strength and

endurance
● sit-up
● press up
● squat
Cardiovascular fitness
GTS AND TREAD MILL
RUN

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Client Screening Form *

FITNESS TRAINER Date

Client’s Name * Gender * Height* Weight* Age*

Client Medical history *

Current Fitness Profile *

Exercise and training history

Client’s barriers to exercise

Specific fitness goals

Informed consent completed YES NO

Clearance letter from a health professional or physician if needed YES NO

Physical Activity Readiness Questionnaire (PAR-Q)*

2. Is there any history of heart disease in your family?

3. Do you feel pain in your chest when you do physical activity/exercise?

Physical Measurements and Fitness Assessments Record

Specific range of movement

HEIGHT : WEIGHT : BMI :

WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 WEEK 6

WEEK 7 WEEK 8 WEEK 9 WEEK 10 WEEK 11 WEEK 12

WEEK 13 WEEK 14 WEEK 15

1. Do you have any allergies?

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Name of the Timings/repetitions Equipment Approach/training THR

PROGRAMME DESIGN FOR WEEK 6 TO 10

PROGRAMME DESIGN FOR WEEK 10 TO 15

Name of the Timings/repetitions Equipment Approach/training THR

Muscular strength and

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