Dance Fitness with Dana
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Dance Fitness Info
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Fitness History
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Name
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First
Last
Rate yourself on a scale of 1 – 5 (1 indicating the lowest value).
How would you rate your current cardiovascular capacity?.
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5 - My heart is like an athlete!
4 - I can run and talk to a friend.
3 - I can exercise for 30 minutes non stop.
2 - I can walk, running I lose my breath
1 - I get out of breath going up small steps
How would you rate your muscular capacity?
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5- I'm a gym meat-head! But I love it!
4- I do resistance training 3+ times a week
3- I lift heavy objects all day
2 - my muscles are very weak
1 - I barely move all day
Do you currently exercise?
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Yes
No
If yes, how often?
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Do you find yourself starting an exercise program then unable to stick with it?
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Yes
No
If yes, what is your reason for stopping?
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Do you have any joint mobility issues?
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Yes
No
If yes, explain.
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Have you had any recent surgeries?
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Yes
No
If yes, explain
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Are there any exercises you cannot perform? If yes, Explain..
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What is your 6 week Fitness Goals?
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