Better Life Training Online Training

Introduction Questionnaire and Consent Form



Assessment Objectives


The assessment you are about to undergo is designed to give a reasonable measure of your current level of fitness, and will include the following:
  • Aerobic Capacity
  • Body Composition
  • Lung Function
  • Flexibility
  • Muscular Strength
  • Muscular Endurance
  • Sport Specific Testing

Please answer each of these questions as accurately as you can. All responses will be treated in a confidential manner.


(*Required entries)

*Name:

*Address:

*City:

*State:

*Zip Code:

*Home Phone:

Work Phone:

Mobile Phone:

Fax:

*Email Address:

*Gender:

Male: Female:

*Date of Birth:

Year   Month  Day

INFORMED CONSENT AND LIABILITY WAIVER:

Explanation of Procedures :


I understand each test will be explained to me and any questions I have will be answered. Specialized equipment may be used to perform the assessment, and I can stop the test at any point if I feel uncomfortable or cannot continue.

Potential Risks:


I understand that a level of exertion is required during this test that will temporarily increase my heart rate and raise my blood pressure. If I have cardiovascular or other disease - whether diagnosed or undiagnosed - I understand that I can be at significant risk for adverse events or even dealth. In addition, as with all vigorous physical activity, there exists a risk of musculoskeletal injury. I understand that while these outcomes are rare, it is quite common to experience some stiffness in the muscles in the 24 - 48 hour period following testing. I understand my trainer is experienced in performing assessments and first aid and will respond quickly to any problems.

Potential Benefits:

I understand the results of this assessment will help to determine my present level of fitness, and highlight my abilities and any areas of specific need. This will be particularly useful when designing my exercise program so that it can be personalized, safe, and effective.

Consent:

I have read the information on this page and I understand it. Any questions concerning the information and procedures have been answered to my satisfaction. I also understand that I am free to stop the assessment at any time and seek professional medical advice or opinion. Any information derived from the assessment is confidential and will not be disclosed without my permission to anyone other than my doctor or the staff of this facility.

Liability:

I understand that I am being advised to consult my doctor before beginning any training program. Better Life Training, Mike Hartman, and Echo Net Media are not responsible for any injury you may sustain in the course of your assessment or workouts.

*I have read and accept the terms of the informed consent and liability waiver form.