View Assessments
View assessments from:Anthony Bear
Send a Message Phone: 4156137300 Email: service@humanitymedia.net
Your Assessment
Why are you here?
dsfd
Assessment Number One: Gait Analysis
Assessment Number Two: Overhead Squat
Assessment Number Three: Low Core Activation
Your Health History Questionairre
1.Birthday:
September 26, 1976
2. Tell us about your health and fitness goals?
Really want to do lots of stuff.
3. Why are these important to you?
I am really into it
4. How committed are you to achieving them.
Life-time
MEDICAL HISTORY 1
5. Please list the bones you have broken in your lifetime: Please describe the incident and the year the injury occurred.
Broken knee
6. Please list the joint injuries and/or surgeries you have endured: Please describe the injury and the year(s) the injury occurred.
Lyme's Disease
7. Please list and briefly describe the car accidents you have been involved in, however minor, and the year.
Car accident in 2000
MEDICAL HISTORY 2
8. Please list all blows to the head that resulted in concussions and the year they occurred.
Concussions
9. Please list all major surgeries and health incidents and the year they occurred.
Eye surgery
10. Are you currently under the care of a physician or health practitioner?
Yes
If yes, please explain.
High blood pressure
CURRENT CONDITION
11. Please list any medications you are currently taking.
Vitamins
12. Tell us about past physical/movement activities you have been involved in.
Yoga
13. Tell us about current physical/movement activities you are involved in.
Yoga and Hiking
14. What does your ideal weekly physical/movement schedule look like?
1 hour per day minimum
HABITS
15. Tell us about your typical sleep schedule.
When do you rise? 6:00 AM
When do you go to Bed? 11:00 PM
Energy Level in the Morning: 3
Energy Level Midday: 7
Energy Level Night: 2
When do you go to Bed? 11:00 PM
Energy Level in the Morning: 3
Energy Level Midday: 7
Energy Level Night: 2
16. Nutrition: Please share with us on a typical day what your food and beverage consumption looks like.
All organic
Optional (and recommended!):
17. Please describe the primary sources of stress in your life:
Cash flow
18. What in your life do you want to change?
Cash flow
19. What is your greatest responsibility? Challenge?
Love
20. What is your life purpose?
Love
Your Health History Questionairre
1.Birthday:
2. Tell us about your health and fitness goals?
3. Why are these important to you?
4. How committed are you to achieving them.
MEDICAL HISTORY 1
5. Please list the bones you have broken in your lifetime: Please describe the incident and the year the injury occurred.
6. Please list the joint injuries and/or surgeries you have endured: Please describe the injury and the year(s) the injury occurred.
7. Please list and briefly describe the car accidents you have been involved in, however minor, and the year.
MEDICAL HISTORY 2
8. Please list all blows to the head that resulted in concussions and the year they occurred.
9. Please list all major surgeries and health incidents and the year they occurred.
10. Are you currently under the care of a physician or health practitioner?
No
CURRENT CONDITION
11. Please list any medications you are currently taking.
12. Tell us about past physical/movement activities you have been involved in.
13. Tell us about current physical/movement activities you are involved in.
14. What does your ideal weekly physical/movement schedule look like?
HABITS
15. Tell us about your typical sleep schedule.
When do you rise?
When do you go to Bed?
Energy Level in the Morning:
Energy Level Midday:
Energy Level Night:
When do you go to Bed?
Energy Level in the Morning:
Energy Level Midday:
Energy Level Night:
16. Nutrition: Please share with us on a typical day what your food and beverage consumption looks like.
Optional (and recommended!):
17. Please describe the primary sources of stress in your life:
18. What in your life do you want to change?
19. What is your greatest responsibility? Challenge?
20. What is your life purpose?