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Health Assessment
Assessment Information
Client Selection
(Required)
Select Client
Cucumber
Exercise Physiologist - Kenji Ueda
Matt Morris
Zachary Whetzel
Date of Assessment
(Required)
MM slash DD slash YYYY
Client Email
(Required)
Client Information
Gender
(Required)
Male
Female
Birthday
Month
Day
Year
Approximate Age
Body Composition
Height
(Required)
in inches.
Height
(Required)
converted to centimeters.
Weight
(Required)
Weight
(Required)
converted to kilograms.
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 Information
Test Selection
Select the test from the dropdown.
Sub Max Test
Max Test
Sub Max Test
Rockport
6 Minute Walk Test
Step Test
Max Test
1.5 Mile Run
12 Minute Cooper Run
Rockport Test
Time - Minutes
Total number of minutes taken.
Time - Seconds
Additional seconds taken.
Heartrate
VO² Max
6 Minute Walk Test
Distance Walked in Miles
(ex 1.15)
Heartrate
Systolic BP
mm Hg
VO
Step Test
Stepping Frequency
Steps/minute
Step Height
inches
VO2
Flexibility Information
Flexibility Test
Sit and Reach Test
FMS Test
Sit and Reach 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
.
FMS Test Total
Muscle Endurance Information
Partial Curl Test
