NC // NOVOS COMEÇOS v6

NITERÓI NC // Fit

TURMA 2024.02

Dados Pessoais

DATA NASCIMENTO

TELEFONE CELULAR

NOME

SEXO

PESO (Kg)

ALTURA

OBJETIVO (Patológico, Saúde ou Estética)

Sobre sua saúde

LESÃO OU DOENÇA

Possui alguma? Há quanto tempo? Como começou? Onde? Consegue identificar a origem? Qual é o grau?

SENTE DOR

Como você se sente? Como é essa sensação fisicamente?

SINTOMAS, DESCONFORTO, INCÔMODO

Você sente algum? Com que frequência isso ocorre? Por quanto tempo dura cada vez?

QUAIS CIRCUNSTÂNCIAS

Algum ambiente ou algo ao redor te afeta? Algo piora ou melhora os sintomas, desencadeia ou alivia?

Possui algum problema de saúde progressivo? (Ex: Pressão alta, Diabetes) Ou toma remédios regularmente?

Tem alguma alergia?

Possui hábitos de vida prejudiciais? (Ex: tabagismo, alcoolismo, sedentarismo)

Compartilhe conosco... há algum histórico familiar relevante?

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