Template 患者信息 代谢评估表模板

代谢评估表模板

代谢评估表模板

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18
Questions
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Metabolic Assessment Form Template

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1.
Full Name
2.
Email Address
3.
Phone Number
4.
Date of Birth
5.
Gender
Male
Female
6.
List any diagnostic tests you have had in the past year
7.
Describe other therapies you've tried for your current health concerns and their results
8.
How many times do you work out per week?
9.
How many caffeinated beverages do you consume per day?
10.
How many alcoholic beverages do you consume per week?
11.
How many cigarettes do you smoke per day?
12.
How many times do you eat out per week?
13.
On a scale of 1 (lowest) to 10 (highest), how would you rate your average weekly stress level?
14.
How often do you eat raw nuts or seeds per week?
15.
How many times per week do you eat fish?
16.
List any medications you take and the conditions they treat
17.
List any natural or dietary supplements you take and the reasons for them
18.
Sensation that the bowels do not empty completely
Least / Never
Most / Always
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Template instructions
代谢评估表模板帮助私人教练和健身专业人士记录客户在休息和活动期间如何燃烧卡路里。使用此模板收集摄入量详细信息、生活习惯、病史和指标,以设计量身定制的训练计划。

这个免费模板包括姓名、联系人、出生日期、性别、诊断测试、尝试的疗法、锻炼频率、咖啡因和酒精摄入量、吸烟、饮食习惯、压力水平、药物和补充剂清单以及肠道功能等字段。问题的结构可在任何设备上快速完成客户端。

使用场景包括初始客户评估、进度跟踪、培训前筛查和营养咨询。该表单可通过拖放构建器进行自定义,支持集成(Google Drive、Dropbox、Airtable),并安全地存储提交内容以供培训师查看和共享。

单击“使用此模板”自定义并发布您的代谢评估表,并立即开始收集客户数据。您无需编码即可编辑问题、品牌和通知,确保专业的客户体验。

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1

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2

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3

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