Food and Fitness Coach Health Status Questionnaire 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, Personal and Emergency Contact Information. Fill in your name, date of birth, address, phone number, physician’s name, height, and weight. Ensure accuracy as this information is crucial for your health assessment.
3. Move to Section 2, General Medical History. Carefully check any conditions you have experienced related to heart history and symptoms. This section helps identify any potential risks associated with physical activity.
4. In Section 3, Risk Factor Assessment, review the list of risk factors for coronary heart disease. Check all that apply to you; this will assist in evaluating your readiness for exercise.
5. Proceed to Section 4 regarding Medications. Indicate if you are currently taking any medications and provide details on their frequency. This information is vital for understanding how medications may affect your exercise program.
6. In Section 5, Physical Patterns and Objectives, describe your weekly exercise routine including type, frequency, intensity, and duration. Also list specific goals for your exercise program to help tailor your fitness journey.
7. Finally, review the Patient Information Release Form at the end of the questionnaire. If applicable, sign and date it to allow communication with your physician regarding any significant health concerns.

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