Health Assessment

Health Assessment

Health Assessment

Male/Female *

Emergency Contact Information

The following questionnaire is not intended for diagnosis but rather to fully understand your health history as well as to help identify your health, fitness and nutrition goals.

There are no incorrect answers, it is only important that you answer honestly and completely.

We look forward to working with you!

Sozo Health and Fitness


1. Have you ever done resistance/strength training before? *
2. What type of exercise do you prefer? *
3. Do you currently have a fitness routine? (If so please explain below.) *


3. Do you experience points during your day when you are tired?

Health History

1. Do you have high blood pressure? (Healthy is considered to be 120/80 mmHg, High BP is 140-159/90-99 mmHg.) *
2. Do you have high cholesterol levels? (Healthy is considered to be less than 200mg/dL, borderline high is 200-239 mg/dL, high is 240 mg/dL and above.) *
3. Do you experience pain in any of these areas? *
4. Do you smoke? *
5. Are you taking any medications or supplements? *


1. Do you have any food allergies? *
2. What times do you regularly eat within a day and what do you eat? (Example: 7am: Omelet w/ Veggies, 10am: Fruit w/ Yogurt, etc...) Enter Wake up time here.
3. Do you experience points during your day of significant hunger? *
5. Do you drink coffee? *
6. At what time of day are you most likely to drink coffee and how many cups?

7. Do you drink soda pop? *
8. At what time of day are you most likely to drink soda pop and how much?

9. Do you drink alcoholic beverages? *
10. What time of day are you most likely to drink, what type of alcohol and how much?


I agree that all information stated in this document is accurate and complete.
I understand that a facsimile, electronic, pdf or DocuSigned signature will have the same force and effect as an original.