Template Patient Information Metabolic Assessment Form Template

Metabolic Assessment Form Template

Metabolic Assessment Form Template

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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
Metabolic assessment form template helps personal trainers and fitness professionals record how clients burn calories at rest and during activity. Use this template to collect intake details, lifestyle habits, medical history, and metrics to design tailored training plans.

This free template includes fields for name, contact, birth date, gender, diagnostic tests, therapies tried, workout frequency, caffeine and alcohol intake, smoking, eating habits, stress level, medication and supplement lists, and bowel function. Questions are structured for quick client completion on any device.

Use scenarios include initial client assessments, progress tracking, pre-training screenings, and nutrition consultations. The form is customizable with a drag-and-drop builder, supports integrations (Google Drive, Dropbox, Airtable), and stores submissions securely for trainers to review and share.

Click "Use This Template" to customize and publish your metabolic assessment form and start gathering client data immediately. You can edit questions, branding, and notifications without coding, ensuring a professional client experience.

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1

Use This Template

Click "Use This Template" to open it in SurveyMars. You can preview and test it without signing up.

2

Customize Your Survey

Edit questions, upload your logo, and match the design to your brand. Create professional surveys with no technical skills required.

3

Share & Collect Responses

Share by link, QR code, or embed it on your website. Responses appear in your dashboard as soon as they come in.

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