health survey

Topics: Weight loss, Obesity, Medicine Pages: 2 (313 words) Published: December 2, 2013
Health Survey
Complete all health and fitness status questions. Ask for assistance from your parents or guardians if needed.  
Personal Information
Height _5.1_______
Weight _175_______
Health Status
1. Yes_____ No ____ Do you have any medical situation that would limit your participation in any physical activity? NO *If yes, please write a detailed explanation of the medical issue and the specific activities you cannot participate in.  

2. Rate your present medical condition:
__yes___ Excellent _____Good _____Fair _____Poor  *If you selected Fair or Poor and you do not have a condition that is explained in item #1, explain why you have rated yourself in this way.  

3. Describe two or more physical activities you participate in outside of a school setting. They could be within your city, community, neighborhood or family. Include how often you participate, such as a daily or weekly basis. Every 3 days a week I play soccer with my family and friend for 2 or 1 hour .

4. Explain how your friends positively and negatively influence your decisions to be physically active and to make healthy choices. They have positively influenced my decisions to be physically active to make healthy choices .  

5. What areas of your health and body would you like to improve?
_yes____ Flexibility
__yes___ Cardiovascular endurance
_yes____ Upper body strength
_yes____ Lower body strength
_yes___ Body composition
_yes____ Increase weight
_yes____ Decrease weight
__yes___ Decrease percentage of body fat
__yes___ Increase physical activity level

6. Go to the course Announcement page. List three things from the Announcement page content that you will use to help you succeed in your Personal Fitness course OR three things that you would like to see on your course Announcement page which might be beneficial to you. A. doing hard exercise to lose weight .

B. I will success in personal fitness by...
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