» Elderly

Step 1 of 7 - Personal details

(Required)

First Name Last name

Date of birth(Required)

Month

Day

Year

Gender(Required)

Level of education(Required)

Field of Study(Required)

Employment status(Required)

Job(Required)

Phone Number(Required)

Email (Result are sentvia email)(Required)

Payment (50$ )

Please email transfer to: Dr.Bahrami@gmail.com or Paypal to: Dr.Bahraminejad@yahoo.com

The name of the payer:(Required)

Date of payment(Required)

Month

Day

Year

Payment receipt(Required)

Max. file size: 256 MB.

Height (cm)(Required)

Current weight (measure your weight in the morning with underwear after toilet(Required)

What is your normal weight? (kg)(Required)

Waist circumference (Measure the smallest circumference with a tape(Required)

Hip circumference (Measure the biggest circumference with a tape)(Required)

3 points priorities of body fat distribution (Priority 1)(Required)

Priority 2

Priority 3

Fat percentage (with caliper or body composition analysis device)

Send body composition file

Max. file size: 256 MB.

Do you currently have a specific illness?

Please mention the type and duration of the disease(Required)

Have you ever been hospitalized?

Please state the reason for hospitalization and its time in full(Required)

Do you have a special injury or limited mobility?

Mention the type of injury or movement restriction(Required)

At what times and with what factor does the pain intensify and subside?(Required)

Have you ever experienced heart palpitations or shortness of breath?

Please describe the process of palpitations or shortness of breath(Required)

Do you get dizzy and headache?

Explain its type and amount(Required)

Do you have digestive problems?

Explain its type and amount(Required)

If there is a particular disease in the first degree relatives, mention it(Required)

Assess the stresses of your life and work environment(Required)

Do you take any special medication?

Please specify the type and amount of medicine(Required)

Do you take supplements or vitamins?

Please specify the type and amount of medicine(Required)

Do you use cigarettes, alcohol or drugs?

Explain its type and amount(Required)

Are you allergic to a certain substance?

Explain the type of sensitivity and its symptoms(Required)

Can you raise both your hands above your head without pain?

In case of pain and disability, explain the conditions(Required)

Can you easily rub the back of your shoulder from below with each hand?

If unable, explain(Required)

Can you squat without knee and hip pain?

In case of pain and disability, explain the situation(Required)

Can you touch your toes while sitting flat on the floor?

If unable, explain(Required)

Can you run?

If unable, explain(Required)

blood pressure (minimum)

blood pressure (maximum)

If possible, send a radiology picture of the knee

Max. file size: 256 MB.

If possible, send a radiology picture of the lumbar vertebrae

Max. file size: 256 MB.

Purpose of training program(Required)

If you need to change your weight, complete the food plan questionnaire

Fully explain your mobility limitation(Required)

Do you have a special desire to shrink a part of your body?(Required)

If you need to change your weight, complete the food plan questionnaire

Please name the desired parts(Required)

Do you have a special desire to become muscular and bulky in a part of your body?(Required)

Please name the desired parts(Required)

Do you have any special restrictions for going to sports places?

Mention the training location(Required)

What training tools do you have?(Required)

Do you have a desire to take supplements and vitamins?

Please send photos of your training equipment

Max. file size: 256 MB.

Please specify only the days and times you want to do exercises(Required)

Saturday morning

Saturday evening

Sunday morning

Sunday evening

Monday morning

Monday evening

Tuesday morning

Tuesday evening

Wednesday morning

Wednesday evening

Thursday morning

Thursday evening

Friday morning

Friday evening

Which of the following methods do you prefer for endurance training?

Free at the discretion of the coach

Running in open space

Running on a treadmill

Outdoor cycling

Stationary bike

elliptical

Swimming

Mountain climbing

Roping

Which of the following methods do you prefer for strength training?

Free at the discretion of the coach

Strength machines

free weights

Body weight training

rubber band

Please provide a summary of your training record for the past 2 months(Required)

Have you already received the training program from the site?

In what language would you like to receive your training plan?(Required)

Please, in addition to criticisms and suggestions, if you think there is something special, write it in the form below.

If you want, you can send a photo of your body

Max. file size: 256 MB.

While accepting the accuracy of the above information, I request the annual training program (required).