-Ficha Avaliao Fsica

Nome:__________________________________________ Data Nasc._______________

Histrico Clnico:_______________________ Familiar____________________________
Limitaes:______________________________________________________________
PA Repouso________mm FC
repouso:______bpm
MC______Kg
Estatura_______cm
RCQ_________
IMC___________
Permetros(Protocolo Pollock)
Torax ______________
Cintura
______________
Abdomen ____________
Quadril
______________

D
E
Antebrao _________
___________
Brao
_________ ___________
Coxa
_________
___________
Panturrilha________ ___________

Composio Corporal por Dobras Cutneas (Protocolo Pollock, 7

DC):
Subscapular__________
Axilar-mdia_____________ Coxa___________
Triciptal___________
Supra-iliaca_____________
Peitoral____________
Abdominal_____________
Gordura
Atual:___________
Peso
Gordo:______________kg
Peso
Magro:___________Kg
Composio Corporal Por Bioimpedncia (Bipolar Bike Queens)
Gordura Atual:______ Peso Gordo:______Kg Peso Magro:______kg IMC:_____
TMB:_______
Composio Corporal por Perimetria (Protocolo Penroe)
Homem: Punho_________Abdomen__________
Mulher: Abdmen_________
Glteos___________
Gordura
Atual:___________
Peso
Gordo:______________kg
Peso
Magro:___________Kg
Avaliao Cardiovascular (Protocolo
VO2 max______________l/min
Classificao__________________
Neuromotores:
Flexes:____________Classificao:_______________
Abdominais:_________Classificao:_______________
Indicaes:
( ) RML
( ) Aerbico
( ) Alongamento ( )Musculao
( ) Medex ( ) Abdominal
( ) Up Hill
Observaes:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Avaliador (a) Responsvel:
________________________________________________________

Data
Avaliao:
Hora:________________

____________/____________/________________