Female - Health & Performance Metrics v3
Female - Health & Performance Metrics v3
Female - Health & Performance Metrics v3
Personal Information
First Name
*
Last Name
*
Phone
*
Email
*
What is your #1 Goal?
*
Are you an Athlete?
*
No
High School Athlete
College Athlete
Professional Athlete
Notes to DFR Coaching team
Visual
Code
Your DuPage Fit Total Fitness Index
Your DuPage Fit Life Span Index
Your DuPage Fit Health Span Index
Your DuPage Fit Aesthetic Index
Your DuPage Fit Performance Index
Your DuPage Fit Athletes Index
DuPage Fit Labs Index
Your DuPage Fit Lab Test Index
Your HA1C
*
LDL
*
Vit D
*
Triglycerides
*
Cholesterol
*
HDL
*
Trig./ HDL Ratio
*
DuPage Fit Cardio Index
Your DuPage Fit Cardio Index
Systolic
*
Diastolic
*
1 Mile Walk/Run
*
Pulse
*
PRS Pulse
DuPage Fit Aesthetic Index
Your DuPage Fit Aesthetic Index
Weight
*
Height in feet
*
Height (Inches)
*
Neck Circumference
*
Shoulders Circumference
*
Waist Circumference
*
Hips Circumference
*
Waist to Hip Ratio
PRS BMI
DuPage Fit Orthopedic Index
Your DuPage Fit Orthopedic Index
Push-Ups
*
Greater Than 35
34 to 30
29 to 20
19 to 10
Less Than 9
Chair Squat
*
Plank
*
1 Mile Walk/Run
Mobility Squat
*
6 Point Upper Body Mobility
*
Please Select a Value
Butt contacts the wall
Butt & shoulder contact the wall
Butt, shoulder, back of head contact the wall
Butt, shoulder, back of head & elbows contact the wall
Butt, shoulder, back of head, elbows & wrists contact the wall
Butt, shoulder, back of head, elbows, wrists contact the wall and the arms vertically lengthen while maintaining contact with the wall
Toe Touch
*
Chronic Pain
*
Please Select a Value
No Pain in any joints
Intermitttent pain in a joint
Constant Pain in one joint
Constant Pain in two joints
Constant Pain in 3 or more joints
DuPage Fit Athletes Index
Your DuPage Fit Athletes Index
Box Vertical Leap
*
40 yard Dash
*
Standing Broad Jump
*
5-10-5 Cone Drill
*
60 sec Jump Rope
*
Bench press
*
Pull-up
*
Leg Press
*
60 sec Sit-ups
*
Protein Intake (g)
*
DuPage Fit Life Style Index
Your DuPage Fit Life Style Index
Age
*
Typical Total Daily Sleep Hours:
*
Exposure to second hand smoke or direct use of tobacco products
*
Please Select a Value
None
Social
Daily Use
Weekly Alcohol Intake (# of Drinks)
*
Please Select a Value
O Drinks
1 to 7 drinks
8 to 14 drinks
15 to 21 drinks
Lifestyle Activity Pattern (5 -7 days a week)
*
Please Select a Value
10,000-15,000 steps daily
7,500-10,000 steps daily
5,000 to 7,500 steps daily
<5,000 steps
Typical amount of weekly exercise
*
Please Select a Value
7-10 Hours
5-6 Hours
4 hours
Less Than 4 hours
PRS Sleep HRS
Your DuPage Fit Nutrition Index
Your DuPage Fit Daily Nutrition Index
Water in cups (note 8 oz = cup)
*
Please Select a Value
12 to 10 servings
8 to 6 servings
6 to 4 servings
Less than 3 serving
Leafy Green Veggies (cups)
*
Please Select a Value
10 to 8 servings
7 to 5 servings
4 to 2 servings
Less than 1 serving
Solid Colored Veggies or fruits (cups) - Weekly
*
Please Select a Value
6 to 5 servings
4 to 3 servings
2 servings
Less than 1 serving
Beans (not baked beans) cups
*
Please Select a Value
3 servings
2 servings
1 serving
Less than 1 serving
Plain Unsalted or Roasted Seeds or Nuts (cups)
*
Please Select a Value
4 servings
3 servings
2 serving
Less than 1 serving
Daily Processed Food Servings
*
Please Select a Value
0 servings
1 serving
2 servings
3 or more servings
Weekly Seafood and fish servings
*
Please Select a Value
4 Servings or more
3 Servings
2 Servings
7= 1 Serving or less
Date
If you are human, leave this field blank.
Submit
Insert/edit link
Close
Enter the destination URL
URL
Link Text
Open link in a new tab
Or link to existing content
Search
No search term specified. Showing recent items.
Search or use up and down arrow keys to select an item.
Cancel