How to find your BMI and RHR

WholyFit Leader Directions:

Each participant completes this form before beginning to practice WholyFit (or as soon as possible) and each participant will complete it again every 3 months to re-assess periodic improvement. It is your responsibility to do this health screening and improvement assessment and also you may supplement with other own independently collected forms as provided on the Rollout Page. Once submitted, admin will forward the results back to the participant and WholyFit leader, if indicated.

WholyFit Participant Directions:

Please fill out this form honestly, as of today. It will remain private between your fitness leader and yourself. It will be included in data/statistics analysis by WholyFit Corporate to prove the effectiveness of WholyFit over time. Thank you and God bless you!

Thank you for submitting this form. May God bless you!

* indicates required field

Name:*

Email:*

WholyFit Leader Email (usually first name.last name@wholyfit.org):

1. Length of time involved in WholyFit:*

1. Never before
2. 1-3 Weeks
3. 3-6 Weeks
4. 6-12 months
5. 1 to 2 years
8. 2 to 3 years
9. 3 to 4 years
10. 4 to 5 years
11. 5 to 6 years
12. 7 to 8 years
13. 8 to 9 years
14. 10 years or more

2. Do you have any pain(s), issue(s) or previous injury that may feel bad/worse during exercise?*

3. Exercise:*

1. As of today, I do not consider myself a fitness person
2. As of today, I would describe myself as a fitness person

4. I exercise ___ times per week*

1. One
2. Two
3. Three
4. Four
5. Five
6. Six or seven

5. In each session I exercise for an average time of____.*

1. 5-15 minutes
2. 20-30 minutes
3. 35-45 minutes
4. 45-60 minutes
5. an hour or more

6. On a scale of 1-5, on the average, I exercise this hard in each session:*

1. very gently
2. at a low intensity
3. at a moderate intensity
4. at a high intensity
5. at the highest intensity or performance based or at a competitive sport level

7. Do you or have or have a family history of: 1. Heart Disease 2. Cancer 3. Neuro-endicrine 4. Diabetes*

8. Medications:*

9. Surgeries:*

10. I sleep well and do not awaken in the night. (Gauge on scale of 1-5)*

1. No
2.
3.
4.
5. Yes

11. I enjoy exercise*

1. No
2.
3.
4.
5. Yes

12. I have a wonderful social support system. (Gauge on scale of 1-5)*

1. No
2.
3.
4.
5. Yes

13. I am usually energetic. (Gauge on scale of 1-5)*

1. No
2.
3.
4.
5. Yes

14. I maintain hopefulness even when bad things happen. (Gauge on scale of 1-5)*

1. No
2.
3.
4.
5. Yes

15. Is your food consumption pattern healthy? (Gauge on scale of 1-5)*

1. I eat too little or too much
2.
3.
4.
5. I eat an appropriate amount of food, not too little, not too much

16. I feel close to certain people and have good friends. (Gauge on scale of 1-5)*

1. No
2.
3.
4.
5. Yes

17. Height:

18. Weight:

19. BMI (If needed, ask WholyFit Leader for help):

20. Resting Heart Rate (If needed, ask WholyFit Leader for help):

21. Total Cholesterol (if known):

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