ENGLISH

First Name:Jimena

Last Name:Suárez

Personal Fitness

1. Presently, do you exercise on a regular basis? If yes, describe the exercise routine:

2. How many days per week do you exercise? 4 days a week

3. How many minutes each day?60

4. What exercises do you most enjoy?skating

5. What exercises do you least enjoy?I`m not sure

6. Do you watch TV/ play video games or stay on the computer for more than two hours per day?No

Diet and Nutrition

1. How would you describe your daily nutritional habits? Unhealthy? Erratic? Healthy? Erratic

2. How often do you eat fruit and vegetables? 4

3. How often do you eat at fast food restaurants? 1 on 2 weeks

4. List any medications you take on a regular basis. Include vitamins and supplements.Yes

Medical History

1. Are you currently under a doctor’s care? If yes, explain why.No 2. When was the last time you had a physical examination?

3. Have you recently been hospitalized? If yes, explain why.

4. Do you have a grandparent, parent, or sibling who, prior to age 55 has had: a heart attack?

a stroke?

high blood pressure?Grand mother

high cholesterol?aunt and uncles

Weight (obesity) problems? No