My Health
Profile
DATE
_______________
AGE _______________
AMBIENT
HEART RATE _______________
RESTING
HEART RATE _______________
BLOOD
PRESSURE _______________
CHOLESTEROL _______________
NUTRITIONAL ASSESSMENT
NUMBER
OF CUPS OF COFFEE OR SODAS A DAY ___________
DAILY
INTAKE OF WATER ________ (OUNCES)
VITAMINS __________________________________________________________
MINERALS __________________________________________________________
BEST
EATING HABIT ___________________________________________________
WORST
EATING HABIT _________________________________________________
EXERCISE AND ACTIVITY
ASSESSMENT
I
CURRENTLY EXERCISE _________ TIMES A WEEK
MY
CURRENT EXERCISE PROGRAMS CONTAINS (CIRCLE ONE)
FLEXIBILITY
AEROBIC
ANAEROBIC
SPORTS
PARTICIPATION _______________________________________________
CHANGES
TO BE MADE IN EXERCISE ROUTINE
________________________________________________________________________________________________________________________________________________
CHANGES
TO BE MADE IN NUTRITION
________________________________________________________________________________________________________________________________________________
6 WEEK REVIEW DATE
________________
AMBIENT
HEART RATE _______________
RESTING
HEART RATE _______________
BLOOD
PRESSURE _______________
CHOLESTEROL _______________
Fitness Information Training Services — 708-212-FITS — barry@fitsusa.com — www.fitsusa.com