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The Human Performance Laboratory at Meredith College is pleased to provide customized fitness assessments for clients of the Athletic Performance Center. Through this partnership it is our hope that clients determine exactly where they can improve their level of fitness and how to customize a training regimen to accomplish goals.  In order to prepare for your visit...

Please complete the following:

  1. Register for testing and complete the client information form below.  If you do not receive a confirmation from the lab within a few days please contact us to make sure we received your testing request.
  2. Print the Pretest Preparation Checklist (You need the free acrobat reader to view these)
  3. Read the Informed Consent Form (You will sign one of these upon arrival to the laboratory)

For Directions to the Lab, print the following: Map to Meredith College the Lab

APC CLIENT INFORMATION

First Name
Last Name
Street Address
Address (cont.)
City
State
Zip
Work Phone
Home Phone
E-mail
Date of Birth
Age
Sex Male Female
Height
Weight

Emergency Contact Name/Phone #


APC CUSTOM PACKAGES

SELECT YOUR APC PACKAGE

Elite Performance Package

    Package Includes
    • Comprehensive Performance Evaluation conducted at the APC — includes a functional screen, musculoskeletal assessment, and combine-style testing (sport-specific).
    • Dartfish Video Analysis
    • Testing conducted at HPL consists of a fitness evaluation in one cardio activity: run or bike
      • Includes VO2Max, lactate threshold/training zone, power/pace training zones, substrate utilization and body composition analysis
    • One month home training program customized to your testing results

    Platinum Performance Package
    Package Includes
    • Testing conducted at HPL consists of a fitness evaluation in one cardio activity: run or bike
      • Includes VO2Max, lactate threshold/training zone, power/pace training zones, substrate utilization and body composition analysis
    • Follow up consultation with an APC Sports Performance Specialist conducted at APC
    • APC staff will accompany you to the HPL testing for an additional fee

Who are you working with at APC?  

TEST DATE

If you have already scheduled your testing through the APC you will recieve an official lab confirmation within a feww days after submitting this form.

If you are in need of an appoitment time you may go ahead and complete this online form without choosing a date and lab staff will respond to you with available dates and times.

Health History Questionnaire

Have you had physiological testing done in the past? Yes No
Chest pain or discomfort Yes No
Palpitations or skipped beats in your heart Yes No
Rapid heart rates at rest Yes No
Dizziness or fainting Yes No
Severe shortness of breath at rest or with usual activities Yes No
Swollen feet or ankles Yes No
Severe pain in legs with usual activities Yes No
Known heart murmur Yes No
Severe back pain Yes No
Spinal disc problems Yes No
Broken bones in the past year Yes No
Recently required physical therapy Yes No
Hospitalized or required any major surgery Yes No
Diagnosed with disease of heart, lungs, nervous system or other part of the body Yes No
Do you currently have asthma Yes No

Women's Health

Are you currently pregnant Yes No
Have you given birth within the last year Yes No
Cardiac Disease Risk
Has a parent or sibling had a heart attack, bypass surgery or other heart disease prior to age 55 (male) or 65 (female) Yes No
Do you presently smoke Yes No
     If you are an ex-smoker, when did you stop?
Do you have impaired fasting glucose ( greater than 125 mg/dL) Yes No
Do you have Diabetes Yes No
Do you have high blood pressure Yes No
If so, Do you take high blood pressure medication Yes No
Do you have high cholesterol (greater that 200) Yes No
If so, Do you take cholesterol lowering medication Yes No
Do you get less than 30 min of physical activity each day Yes No

If you answered yes to any of the above questions please explain below:

VERIFICATION AND WAIVER

I acknowledge that the information listed above is correct and additional health concerns will be brought to the attention of laboratory staff. The information obtained during my testing in the Meredith College Human Performance Laboratory will be treated as privileged and confidential. It is not to be released or revealed to any person except the laboratory staff without my written consent. Data collected during testing will be provided to me in summary form as represented on this website, raw data will not be provided. The information obtained, however, may be used for statistical analysis or scientific purposes with my right to privacy retained. I understand that accurate information about my health history is required to determine the safest, most effective exercise testing for me. I declare that the information provided on this Health History Questionnaire is true and accurate to the best of my information, knowledge, and belief.

Check here to acknowledge waiver:


 

Phone: (919) 760-8769 - Fax: (919) 760-2341 - hpl@meredith.edu

3800 Hillsborough Street    Raleigh, NC 27607-5298

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©2008 Meredith College | 3800 Hillsborough Street, Raleigh, NC 27607-5298
Phone: (919)760-8769 | Fax: (919)760-2363