Corporate Assessment Form Step 1 of 4 25% Name(Required) First Middle Last Date of Birth DD slash MM slash YYYY Gender Male Female Current Position(Required) Department(Required) EXERCISE HISTORY Please Describe your exercise history in detail Using Exercise, Intensity, Duration and Frequency. Exercise: the type of activity or activities that you participate; the type of work that you do . Intensity: Rank on a scale of 1-10 (10 being hardest) how hard you perceive this present this workout to be. Duration: The length of time of each of your exercise sessions workouts or physical activity. Frequency: the amount of time per week dedicated to exercise or vigorous physical activities. CURRENT TYPE OF EXERCISE/ACTIVITY: Strength Training Yoga Zumba HIIT Pilates Kick boxing Barre Other DURATION OF WORKOUT:30 minutes45 minutes1 hourMore than an hourPer Day/WeekDayWeekINTENSITYLowModerateAdvancedFREQUENCY:Once a weekTwice a weekThrice a weekFour times a weekFive times a weekSix times a weekDaily Do you ever have pain in your Chest or Heart? Yes No Do you ever feel faint or have dizzy spells? Yes No Have you had any surgeries in the last six months? Yes No Are you currently pregnant? Yes No Did you ever have any serious injury? Yes No Any other health conditions, we should know of?What are your fitness and wellness goals?To lose weightTo gain weightTo have a lean bodyTo have a healthy body and state of mindTo maintain weightTo build stamina and strengthDo you eat breakfast every day? Yes No How many cups of tea/coffee do you consume in a day? Once Twice Thrice More than 4 times Do you get a variety of fruits/vegetables every day? Yes No Do you often feel anxious or stressed? Once a week Twice a week Thrice a week Many times Do you get 7-8 hours of sleep? Yes No Do you currently use tobacco products? Could be a cigarette, sheesha or any other form? Yes No If yes, for how many times per day? Once Twice Thrice More than three times Any medical condition we should know of?Any surgeries in the past 6 months? Yes No Do you face any issues with your blood pressure? Yes No How much time would you like to dedicate to your physical activity?Muscle issues: Yes No Bones issues: Yes No Joint issues: Yes No Consent(Required) I agree to the privacy policy.
