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Health Assessment
Client Selection
Select Client
Matt Morris
Bethany Barber
Zack Whetzel
Wes Duncan
Angela Gunter-Forren
Annette Martinez
Date of Assessment
MM slash DD slash YYYY
Client Email
Client Information
Gender
Male
Female
Birthdate
Month
Day
Year
Approximate Age
Issue with Ankles:
Issue with Arms:
Issue with Hands:
Issue with Hips:
Issue with Knees:
Issue with Shoulders:
Issue with Spine:
Body Composition
Height
in inches.
Weight
in lbs.
Height
in centimeters, for calculations.
Weight
in kg, for calculations
Girth
Calf
in centimeters.
Thigh
in centimeters.
Hip
in centimeters.
Waist
in centimeters.
Chest
in centimeters.
Arm
in centimeters.
Neck
in centimeters.
TG
Body Mass Index
Body Fat (%)
Lean (%)
Cardiorespiratory
Test Choice
Sub Max Text
Max Text
Sub Max Text
Rockport
6 Minute Walk Test
Step Test
Max Text
1.5 Mile Run
12 Minute Cooper Run
Rockport Test
Time - Minutes
Total number of minutes taken.
Time - Seconds
Additional seconds taken.
Hidden
Time Calculated
Heartrate
VO² Max
6 Minute Walk Test
Distance In Miles
(ex. 1.15 Miles)
Hidden
Distance In Meters
Heart Rate
BPM
Systolic BP
mm Hg
Rate Pressure Product
bpm・mm Hg
VO
Step Test
Stepping Frequency
Steps/min
Step Height
inch
VO2
Flexibility
Sit and Reach Test
FMS Test
Sit and Reach
in centimeters.
FMS Test
1. Deep Squat
Please enter a number from
0
to
3
.
Toe Touch Test
Able
Not Able
2. Hurdle Step
Please enter a number from
0
to
3
.
Inches
Left Leg Up
Please enter a number from
0
to
3
.
Right Leg Up
Please enter a number from
0
to
3
.
3. In-Line Lunge
Please enter a number from
0
to
3
.
Inches
Left Leg Forward
Please enter a number from
0
to
3
.
Right Leg Forward
Please enter a number from
0
to
3
.
4. Shoulder Mobility Distance:
Please enter a number from
0
to
3
.
(tip of middle finger to distal crease)
L Top:
R Top:
Impingement Test Left
Please enter a number from
0
to
3
.
Impingement Test Right
Please enter a number from
0
to
3
.
5. Active Straight Leg Raise
Please enter a number from
0
to
3
.
L
R
6. Truck Stability Push Up
Please enter a number from
0
to
3
.
Prone Press Up Test:
7. Rotary Stability Quadruped
Please enter a number from
0
to
3
.
Kneeling Lumbar Flexion Test
Please enter a number from
0
to
3
.
Left Up
Please enter a number from
0
to
3
.
Right Up
Please enter a number from
0
to
3
.
Total
Muscle Strength
Upper MS (Bench)
Upper MS (Pushups)
Upper MS (Seated Curls)
Lower MS (Squats)
Lower MS (Leg Press)
Total MS
Muscle Endurance
Partial Curl Up Test
Partial Curl Up Test
