Fitness Assessment Case Notes Form
Record key details and findings for each fitness assessment case.
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
Assessment Type
*
Initial Consultation
Follow-up
Post-Rehabilitation
Performance Evaluation
Other
Client Age Group
Please Select
Under 18
18-30
31-45
46-60
61 and above
Reason for Assessment
Physical Measurements
Rows
Value
Height (cm)
Weight (kg)
BMI
Resting Heart Rate
Blood Pressure
Physical Performance Rating
*
1
2
3
4
5
6
7
8
9
10
Perceived Exertion (Borg Scale 6-20)
Very, very light (6)
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Maximal exertion (20)
20
6 is Very, very light (6), 20 is Maximal exertion (20)
Fitness Domains Evaluation
Rows
Poor
Fair
Good
Excellent
Cardiovascular Endurance
1
2
3
4
Muscular Strength
5
6
7
8
Flexibility
9
10
11
12
Balance
13
14
15
16
Recommendations and Next Steps
Submit Case Notes
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