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We are glad that you have decided to have an assessment completed at the Human Performance Laboratory.  In order to prepare for your visit, we will need to collect some information from you.

Please complete the following:

  1. Register for testing and complete the athlete 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)
  4. Bring a check or cash to the laboratory on your day of testing

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

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 #


TESTING CHOICE(S)

Select any of the following tests:

FITNESS TESTING PACKAGES

Endurance Test (biking) $175.00
Endurance Test (running) $175.00

3 test endurance package (track your fitness an/or get tested on the bike and run) $350.00

Triathlete Package: 2 Endurance tests, swim analysis $350.00

HEALTH TESTING PACKAGES

Calorie Counting Package: Resting Metabolic Rate, Calorie's during exercise, and 7-site body composition $155.00

General Health Package: Resting Metabolic Rate and Hydrostatic Body Composition $85.00

 

INDIVIDUAL TESTS

Resting Metabolic Rate $65.00

Underwater Weighing (% body fat) $30.00

7-site Skinfold (% body fat) $10.00

5 sessions of 7-site skinfold $40.00

 

VIDEO ANALYSIS

Underwater Video Analysis of Swimming $85.00

How did you hear about the testing?  

Are you currently being coached?     Yes No     If so, by whom

Are you currently a member of a club (i.e. triathlon, cycling, running)?   

                                                               Yes No     If so, by what club

Are you a Meredith Student, Faculty, or Staff?

                                                     Yes No

TEST DATE

If you have further questions please contact us hpl@meredith.edu or 919-760-8769.

Summer 2008:

Please contact the lab for current openings at hpl@meredith.edu

Please place your top two choices for testing below:

Date and time of choice #1  

Date and time of choice #2  

 

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