Your Name* :
Your Email* :
Street Address* :
What are the best times to reach you? 6:00 am - 8:00 am9:00 am - 12:00 pm12:00 pm - 5:00 pm5:00 pm - 8:00 pm8:00 pm - 10:00 pm
Work Hours Per Week:
Days available to workout each week:
Please list any medications, vitamins & supplements taken on a regular basis (dose and frequency):
Please list any current illness, recent injuries, recent surgeries or past medical problems or surgeries of note.
Do you have, or have you had, any of the following? Heart DiseaseHeart SugeryAsthmaHeart AttackWheezingDiabetesHeart MurmurEpilepsyHypertensionAnemiaThyroid ProblemsStress FractureChronic InjuryChronic Pain
Explain any items selected above
If female, is there any chance you could be pregnant? yesno
Do you visit a chiropractor? yesno
Get regular massage? yesno
Do you stretch? yesno
Do you do yoga? yesno
Any special medical needs or information the coach should be aware of?
What is your waking pulse? BPM
What is your average resting heart rate? BPM
How is your current fitness level compared to your highest fitness level over the past five years.?
BetterAbout the SameWorse
Describe your current training week including frequency, time (duration) and type of exercise.
Describe your longest single workout in the last four weeks (i.e. bike ride, endurance run):
How many total hours per week do you have available for training Monday through Sunday?
On which day would you prefer your longest workout of the week to be scheduled? (Saturday, Sunday, Other)
How many days per week would you prefer to take off from training?
List all of the events you plan on competing in this year. We understand this schedule is subject to change (in fact, we may suggest you change it).
What is your number one goal of this season (be specific)?
Is there anything else you would like your coach to know?
By checking this box I confirm that all information listed above is correct and complete: