Helpful Forms

Three-Day Dietary Record

The purpose here is to quantify your normal intake so do not alter your eating habits in any way or the resulting analysis, although accurate, will be useless because it will not be representative of your typical diet.

Intended Outcomes Form

This form will help you clarify your goals for your overall health and vitality, including our time together.

Client Intake Form

If you are a first-time client, please print this form, complete it, and bring it along to our first session.

Comprehensive Client Information Sheet

This is your comprehensive client information sheet, in which we will ask you to provide some relevant personal information. The answers to these questions are essential in order to allow us to design an optimized individual fitness program for you.

Exercise History Questionnaire

The Exercise History Questionnaire is used to assess your current fitness level. By properly assessing your overall health, fitness experts can develop an exercise program that is tailored to your specific needs.

Confidentiality Agreement

The Confidentiality Agreement is a non-disclosure agreement that is a legally binding contract in which a person or business promises to treat specific information as a trade secret and promises not to disclose the secret to others without proper authorization.

Informed Consent Form

The Informed Consent is a procedure for obtaining a client's signed consent to a fitness center's prescription and leadership of his/her program. Includes a description of the objectives and procedures, with associated benefits and risks, stated in plain language, with a consent statement and signature line in a single document.

Health History Questionnaire

Supplies the essential information that will assist me as your trainer. It also helps me determine an individual's baseline, or what is normal and expected for that person.

PAR-Q -- Physical Activity Readiness Questionnaire

The PAR-Q is a simple self-screening tool that can and should be used by anyone who is planning to start an exercise program. It is used to determine the safety or possible risk of exercising for an individual based on their health history, and current symptoms and risk factors.

Medical History Form

This form is used to document a person's previous illnesses, present conditions, symptoms, medications, and health risk factors. Used to prescribe appropriate exercise programs.

The Chot Zone Fit Camp

The Chot Zone Fit Camp is for ages 13 and up. All campers must go through the proper screening. Camps are based on class size and is limited to a ratio of 10-15 individuals so the instructor can pay attention to form and assist if needed. This also depends on if the camp is indoors or outdoors.

Zumba Waiver Form

All participants must have a Zumba Waiver Form on file before participating in a class. Classes are based on group size. If you have questions please submit them in the comments on the website.