Online Training

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Personal Data

Name(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Complement City State / Province / Region

Gender(Required)

Female

Male

Others

Profession(Required)

Worked Hours(Required)

Weekly

Date of birth(Required)

MM slash DD slash YYYY

Goals

What are your goals?(Required)

Weight Gain

Weight Loss

Gain of muscle mass

Reduction of body fat

Nutritional Education

Health

Performance

Competition

Aesthetics

Others

Have you had an evaluation before by a trainer?(Required)

Yes

For what purpose?(Required)

MORPHOFUNCTIONAL ASSESSMENT

Weight(Required)

Height(Required)

Last Body Fat

Current Body Fat

Blood Pressure

Diastole

Systole

IN THE LAST 3 MONTHS HAVE YOU EXPERIENCED WEIGHT LOSS OR MAGNETIC MASS INCREASE PROCESS?

Weight Loss(Required)

Yes

Not

Previous Weight(Required)

Results(Required)

Lean Mass Gain(Required)

Yes

Not

Previous Weight(Required)

Results(Required)

Phase that started weight loss or muscle mass increase(Required)

Childhood

Adolescence

Adult

SOCIAL HISTORY

Sleep quality(Required)

Poor

Regular

Good

Great

Wake up what time ?(Required)

Sleep at what time?(Required)

Wake up at night?(Required)

Yes

How many times ?(Required)

Please enter a number greater than or equal to 1.

Wake up tired?(Required)

Yes

Why?(Required)

Smoker?(Required)

Yes

Amount/Day(Required)

Please enter a number greater than or equal to 1.

Ex-Smoker?(Required)

Yes

How long did smoke?(Required)

How long ago did you stop?(Required)

Use Alcohol?(Required)

Yes

Amount/Week(Required)

Please enter a number greater than or equal to 1.

Medication?(Required)

Yes

What medications are you taking?

HEALTH HISTORY

Check everything that applies.

Diabetes - Type 1

Diabetes - Type 2

Arterial Hypertension

AVC

Pulmonary Diseases

Heart Diseases

Kidney Diseases

Hepatic Diseases

Neoplasm

High Cholesterol

Low Cholesterol

High Glycemia

Low Blood Sugar

Hypothyroidism

Hyperthyroidism

Increased Triglycerides

Gastritis

Ulcer

Bone Trauma

Obesity

Surgeries?(Required)

Yes

Please indicate(Required)

OBSERVATIONS HAS | ARTERIAL HYPERTENSION

FAMILY HISTORY

Do you have a family history of high blood pressure?(Required)

Yes

Not

Do you have a family history of diabetes?(Required)

Yes

Not

DIABETES OBSERVATIONS

Do you have a family history of cancer?(Required)

Yes

Not

CANCER OBSERVATIONS

Do you have a family history of obesity?(Required)

Yes

Not

OBESITY OBSERVATIONS

Do you have a family history of cardiovascular diseases?(Required)

Yes

Not

CARDIOVASCULAR DISEASES OBSERVATIONS

Do you have a family history of hormonal disturbances?(Required)

Yes

Not

HORMONAL DISTURBANCES OBSERVATIONS

MENSTRUAL CYCLE

Menstrual Cycle(Required)

Regular

Changed

Presence of pain during the cycle(Required)

Yes

Stress level(Required)

1 😀

2 🙂

3 😐

4 😢

5 😭

5 🤬

Explain

Check every that applies

Premenstrual tension

Pregnant

Post childbirth

Breastfeeding

Aminorrhea 1º - Delayed menarche because they are too thin (low body fat), or because they play excessive sports

Aminorrhea 2º - Interruption of the menstrual cycle due to hormonal disorders, menopause or stress problems

Climacteric - Stage of life where the transition from the reproductive period to the non-reproductive period occurs at the age of 40

Menopause - The decrease or lack of female hormones affect metabolism after 48 to 51 years of age

Do you use birth control?(Required)

Yes

Which one?(Required)

Other Information

Describe any other information relevant to your physical training program (optional).

Do the uploud of three current photos in the positions indicated below:

Notes:

Men: Wear swim trunks or short shorts, no shirts, flip-flops or socks. Make sure the photos are taken in a well-lit environment, with clear focus from neck to toe.
If you have long hair, tie it back.

Women:Wear a bikini without padding on the breasts or buttocks or Lycra shorts with a running crop top. Follow the same guidelines as above, ensuring that the photos are well-lit and clearly focused from neck to toe.
If you have long hair, tie it back.

Important: Do not take photos wearing anything other than the specified clothing.

File

Drop files here or

Accepted file types: jpg, png, jpeg, Max. file size: 2 MB, Max. files: 3.