Client Needs Analysis Form

Purpose of the form: To be used by the Fitness Professional, in consultation with a client, to gather and review appropriate information to inform future program design.

Client Details
GIVEN NAME:
FAMILY NAME:
DATE OF BIRTH:
CONTACT NUMBER:

Pre-Activity Questionnaire Review Fitness Professional to Complete
PHYSICAL ACTIVITY HISTORY
WEEKLY DURATION/FREQ:
MODES:
CURRENT PHYSICAL ACTIVITY
WEEKLY DURATION/FREQ:
MODES:
GENERAL PREFERENCES:
PREFERRED SESSION DURATION:
GOAL-SETTING
SMART FITNESS GOAL:	S
	M
	A
	R
	T

Pre-Exercise Screening Review (APSS) Fitness Professional to Complete
STAGE 1 OUTCOME:
CURRENT ACTIVITY LEVELS:
REFERRAL REQUIRED?
Link to Copy of Completed APSS Tool

Health Check Fitness Professional to Complete
WEIGHT:
HEIGHT:
BMI:
WAIST:
RESTING HEART RATE:
RESTING BLOOD PRESSURE:

Client Notes

Fitness Professional to Complete