Be Beautiful at all (Healthy) Costs

Fitness test

Basic contact information

Today’ date :
First name
Last name
Date of birth


No YES NO Question
1. Has your doctor ever said you have heart trouble?
2. Do you frequently have pains in your heart and chest?
3. Do you often feel faint or have spells of severe dizziness?
4. Has a doctor ever said your blood pressure was too high?
5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated by exercise, or might be made worse with exercise?
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?
7. Are you over age 65 and not accustomed to vigorous exercise?

General habit

  • On average, I smoke cigarettes per day.
  • On average, I drink glasses of alcohol per week.
  • On average, I drink cups of coffee per week

Personal goals statements

In the next 1-3 months, I would like to :

In the next 6-12 months, I would like to :

Specific goals

Weight loss
Weight Gain (muscle mass)
Posture and Flexibility
Stress management
Other health/medical (specify...)

Training availability

  • How many days per week are you available to train, with or without a trainer?
  • What period of the day do you prefer to train?
  • How long are you available to train on each training day?
Submit your fitness test: