Unit 7 Assignment 2: Health Screening (P2, P3, P4, M2, D1)

P2 - Prepare an appropriate health screening programme

Personal details section (1)

Name: ____________________ age: ______ Gender: Male/Female (please circle)

Occupation: _________________________________________________________

Address: ____________________________________________________________

Emergency contact: ___________________________________________________

Phone number: _______________________________________________________

Medical considerations section (2)

Please tick if you had/have any of the following:

- Heart condition
- Diabetes
- Asthma
- Muscular pain
- High blood pressure

If other please state: ____________________________________________________

Do you have pain or major injuries in the following areas?

Neck knees Back Ankles

If other, please give details of the conditions which are not mentioned above:
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
What are your stress levels?

Low Medium High

Resting heart rate: ________________

Maximum heart rate: ______________

Height (m/cm): ____________________

Weight (kg): ______________________




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