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Health declaration form

pilpelit logo fitness trainer 5 final-08

The purpose of the questionnaire is to check your physical condition and your medical history. With these "generic" questions, I can best tailor your workout and / or training plan. Hence, you must deliver the whole truth. If the answer to one of the questions below is "yes", please specify, if any.

I emphasize that in completing the questionnaire you declare that you have provided full and correct information about your medical condition in the past and present, and therefore you confirm that your physical condition is good, and that there are no medical problems that may endanger you during training - and that I am unaware of.

If you do not tell me - I have no way to help. Too bad you're endangering yourself.

המלצה רפואית להימנע מפעילות גופנית
ניתוח בשנה האחרונה
מחלת ריאה\ קשיי נשימה
בעיות גב תחתון\ צוואר
כאבי שרירים\ מפרקים
סוכרת\ בעיה בבלוטות התריס
השמנת יתר
בקע (הרניה) או מצב אחר, אשר לפי ידיעתך, עשוי להחמיר כתוצאה מהרמת משקולות
מחלת הנפילה
האם יש לך אישור מרופא להשתתפות בפעילות גופנית אינטנסיבית?
איבדת את הכרתך ב -12 החודשים האחרונים?
בעיות לב
יתר לחץ דם
מחלה כרונית
קושי במהלך פעילות גופנית
עישון סיגריות
היסטוריה של בעיות לב במשפחה הקרובה
האם הינך נמצא\ת בדיאטה חריפה (פחות מ-1200 קלוריות ביום)

Thanks for the reference!

Health statement - what I need to know, and why you want me to know

You have chosen to train with me, and these trainings, unfortunately, are not frontal. It's important for me to explain that this means that whether you practice zooming, or whether you use the VOD service - I do not see you, and therefore, I do not have the ability to fix in real time, or identify certain problems or signs of distress that your body exhibits during training. Therefore, the responsibility is on you. Tell me everything. Any information you provide me before training will help me tailor the specific training or training program to you in the best and most professional way, and thus, we will both benefit.

Therefore, it is important that you read the health statement below carefully, and that you fill out the questionnaire at the end - just as these are necessary conditions for participating in my training.

If you feel that the statement lacks certain information that is relevant to you, please specify in the "comments" box - or alternatively, talk to me directly.

In general terms:

If in doubt - no doubt.

In other words, if you feel there is something in your body that is painful or uncomfortable, that is permanent or that is ongoing - you must update me. That way, I can tailor certain exercises to you personally, or explain to you what you should avoid. It's in your best interest.


No matter what week you are in - I need to know, and you need to feel comfortable asking me everything. Nevertheless, please read the following highlights carefully, and keep to yourself as follows:

  • Pulse - maximum 150, and it does not matter what type of training it is (power, intervals, etc.).

  • Jumping - preferably without impact, and if you still choose to make a type of jump, then avoid a massive landing

  • Lying on your back - no more than a minute in a row.

  • Do not bend over.

  • If you did not perform a particular exercise before pregnancy - do not perform it during pregnancy.

  • Rests and repetitions - Take longer rests between exercises, and add rests if you feel you need to. Also, do fewer repetitions of each exercise - according to how you feel.

  • In general - and as much as you exercised before pregnancy - you should perform the exercise at 65% "intensity" from how you would exercise before pregnancy, including weight lifting. As the pregnancy progresses - you need to lose weight. Remember this is not the time to “streamline” and improve your fitness. It's time to preserve it.

  • If you experience problems during pregnancy - that is, your pregnancy is not normal (for example, pregnancy at risk) - you should not exercise.

Postpartum women:

  • If you exercise for the first two weeks after giving birth, with or without me - you must act as if you are still pregnant (see above).

  • Did you miss the pepper? In the first six weeks after the birth - you are asked to present me with a doctor's certificate approving you to exercise. As part of the confirmation you must confirm that you have undergone a pelvic floor examination and that it is normal, as well as update me on the condition and type of birth.

If you have passed the age of 55 - congratulations! What fun you came for. Everything is small about you. And a few small guidelines, though:

  • You should consult your doctor and determine what the maximum heart rate is for you for training. I'm asking you to update me. That way I will know how to adapt the training to you in the best way.

  • In general, I recommend avoiding multiple jumps, or any other exercise that you feel does not suit your physical condition.

  • Any joint problem (for example, osteoporosis / calcium leakage) - you must consult with me personally about each workout, so that we can make sure that the workout is really right for you.

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