XFit Assessment - XFit Gym

XFit Consultation & Assessment Form

Full Name

Contact Number

Email Address

Gender

Male Female

Age

Consultaion Date

Consultant Name

Profession

Working Hours

Daily Activity Level

Sedentary Lightly Active Moderately Active Highly Active

Average Sleep Duration

Sleep Quality (1 - 10)

Stress Level (1 - 10)

Water Intake (Liters/day)

Smoking

Yes No

Alcohol Consumption

Yes No

Eating Habit

Vegetarian Mixed Diet Fast Food Frequent Home Cooked

Number of Meals per Day

Breakfast Habit

Regular Sometimes Never

Fitness Goals

Weight Loss Fat Loss Muscle Gain Strength Improvement Body Transformation Posture Correction Rehabilitation Flexibility Sports Performance General Fitness Swimming Performance Stress Reduction Improve Energy Levels

Primary Goal

Target Time Frame

Mortivation Level (1-10)

Do you have any Medical Conditions?

Diabetes Hypertension Asthma Thyroid Disorders PCOS/PCOD Arthritis Back Pain Knee Pain Shoulder Pain None

Current Medications

Previous Surgeries

Doctor Restrictions

History of Injuries

Family Medical History

Have you exercised before?

Yes No

Previous Gym Experience

Years of Training

Current Exercise Frequency

Preferred Activities

Gym Swimming Boxing Yoga Group Classes Running Functional Training Cross Training

Reason for Stopping Previous Training

Eating Pattern

Excellent Good Average Poor

Protein Intake

Low Moderate High

Fruit Intake

Vegetable Intake

Snacking Frequency

Sugar Consumption

Caffeine Intake

Supplements Used

Forward Head Posture

Yes No

Rounded Shoulders

Yes No

Kyphosis

Yes No

Lordosis

Yes No

Anterior Pelvic Tilt

Yes No

Posterior Pelvic Tilt

Yes No

Flat Feet

Yes No

Knee Valgus

Yes No

Mobility Restrictions

Yes No

Comments

Squat Assesment

Shoulder mobility

Core Stability

Balance Test

Flexibility Score

Cardiovascular Endurance

Overall Fitness Rating (1-10)

Current Challenges

Memebr Strengths

Areas for Improvement

Short Term Plan

Long Term Plan

Trainer Recommendations