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Athlete Questionnaire
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* Indicates required question
Email
*
Your email
What type of coaching are you interested in?
*
Performance Coaching (One on One)
Custom Training Plan
Consultation
Swim Video Analysis
Run Video Analysis
Mentoring
Indoor Cycling Training Plans
Required
Full Name
*
Your answer
Address
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Phone Number
*
Your answer
Current Medications
Your answer
Do you have or have you had, any of the following?
*
Heart Disease
Heart Surgery
Hypertension
Asthma
Diabetes
Anemia
Heart Attack
Heart Murmur
Thyroid Problems
Wheezing
Epilepsy
Stress Fracture
None of the above
Other
Required
Check any of the following statements that are true.
*
A doctor has said that you have a heart condition that should limit your physical activity
I have had chest pain brought on by physical activity.
I have developed chest pain within the last month.
I tend to lose consciousness or fall over as a result of dizziness.
A doctor has recommended medication for high blood pressure or a heart condition.
I am aware of other physical reasons that I should not exercise without medical supervision.
None of the above apply to me.
Required
Please explain any of the boxes that you have checked in the last two questions.
Your answer
Please check any of the following questions if your answer is, "Yes."
*
Do you have any metabolic diseases, controlled or uncontrolled, such as diabetes, hyperthyroidism, hypothyroidism, etc.
Do you, or have you ever, smoked regularly?
Do you have high cholesterol?
Have you had any surgery in the last year?
Have you ever had an injury that caused you to stop exercising for more than one month?
Are you, or have you ever been, anorexic or bulimic?
Are there any other physical or emotional problems that may affect your training?
None of the above
Required
Describe your athletic history.
*
Your answer
Describe your training in the last 3 weeks.
*
Your answer
How many hours do you have to train during weekdays and weekend days?
Your answer
What are your most important goals for this season?
Your answer
Type your name below the following statement to represent your digital signature declaring that you have read and agree to the statement.
*
Your answer
Type your name below the following statement to represent your digital signature declaring that you have read and agree to the statement.
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
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