anamnesi - Personal Trainer Valerio Rea
Personal Trainer
Valerio Rea Personal Trainer
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Valerio Rea Personal Trainer
Valerio Rea Personal Trainer
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Valerio Rea
Personal Trainer
Valerio Rea Personal Trainer
×
HOME
WHO WE ARE
WORKOUT
PROPOSAL
GYM
THE METHODS
GALLERY
CONTACTS
Valerio Rea Personal Trainer
Valerio Rea Personal Trainer
Valerio Rea
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HOME
WHO WE ARE
WORKOUT
PROPOSAL
GYM
THE METHODS
GALLERY
CONTACTS
Medical history card
General Anamnesis the fields marked with * are mandatory
Surname and name*
E-mail*
Phone*
Address*
City*
Fiscal Code
Profession
Hours available in the day
Anthropometric data
H (cm)*
Weight (Kg)*
Waist (cm)*
Hips (cm)*
Physical activity
Do you do physical activity?
No
Yes
why
yes, which one / s
How many times / week
If you think about physical activity, what, which image comes to mind immediately?
What sport can you not play?
Did you play sports in the past?
Yes
No
If yes, which one/s
How long ago ?
And for how long?
If you went to the gym, how many times did you attend?
How long ?
What did you do?
With what results
meager
medi
good
Do you prefer single or group activities?
single
group
Do you prefer to train in the gym, outdoors or by the pool?
gym
outdoors
pool
Currently, how many times / week could you train?
How long ?
Which time slot do you prefer?
General physiological notes
Sports medical ECG / e visits under stress
yes
no
Last how long?
Drugs
yes
no
Which ?
Blood pressure
High
Normal
Low
Smoke
yes
How many cigarettes
Smoke
no
How long have you stopped?
Sleep
How many hours do you sleep on average?
From what time to what time
You have a restful sleep
yes
no
Do you ever rest in the afternoon?
yes
no
Feeding
Think about feeding yourself
Very bad
bad
Very well
well
Diseases
Do you have any pathologies to tell me?
heart
thyroid
allergies
hepatobiliary
respiratory
hormonal
orthopedic
diabetes
hypertension
gynecological
nervus
digestive
venous
Have you undergone any surgery/injury?
yes
no
If so, which ones
Use of drugs
yes
no
Se si, quali
Do you have pains to highlight?
Back
Shoulders
Knees
Ankles
Foot
Other
Determined with which exams
Determined with which exams
Determined with which exams
Determined with which exams
Determined with which exams
Medical report
Are you currently followed by a specialist or other professional?
yes
no
If so, which ones
Goal definition
Target
Do you feel motivated to achieve it?
For nothing
Shortly
Quite
Very
If you've tried in the past what will make the difference this time?
How much do you think the achievement of the result depends on you?
For nothing
Shortly
Quite
Very
What do you think will be the biggest obstacle to overcome?
How do you plan to overcome this obstacle/s?
WELL, today is the first day of a new lifestyle. Are you ready?
This message is for:
Elisabetta Mastrobuono
Valerio Rea
Privacy
Consenso al trattamento dei dati personali ai sensi del D. LGS n.196/2003 Ai sensi del D. Lgs. n. 196 del 30 giugno 2003 (“codice in materia di protezione dei dati personali”) che tutela il trattamento dei dati personali, il Trainer di seguito indicato informa il cliente di essere il titolare ed il responsabile del trattamento dei dati personali forniti nel presente modulo e che tale trattamento sarà improntato ai principi di correttezza, liceità, trasparenza e riservatezza. Ai sensi dell’art. 13 della normativa indicata, si informano i clienti che i dati personali forniti saranno raccolti e trattati nel rispetto delle vigenti norme di legge e successive integrazioni e modificazioni, per finalità connesse allo svolgimento ed all’attuazione del programma di allenamento concordato con il V-Trainer. Si informano, inoltre, i clienti che l’interessato al trattamento dei dati personali è titolare dei diritti di cui al Titolo II (articoli 7, 8, 9 e 10) tra cui, in particolare, il diritto di richiedere in qualsiasi momento l’aggiornamento, la rettifica e la cancellazione dei dati mediante comunicazione da inviarsi al Trainer indicato nel presente modulo. Preso atto di quanto sopra, do il consenso al trattamento dei dati personali per le finalità di cui sopra.
I agree
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