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Start Up Kit
Contact Information
Your Name
(required)
Address
How can I contact you?
Phone
Email
Both
Home Phone
Work Phone
Email Address
(valid email required)
Gender
Select
Female
Male
Weight
Height
Date of Birth
Which Sport(s) are you seeking coaching for
Confirmed with Coach?
Help me decide
Doug
Drew
Stephen
Chris
Martin
Gwen
Your other-than-athletic life (Optional)
Occupation
General Work Schedule
Married
Yes
No
Spouse's Name
Children
Your Health History
1. Have you or anyone in your family had coronary artery disease?
Yes
No
If yes, please explain.
2. Do you ever have chest, shoulder, neck, or arm pains after exercise?
Yes
No
If yes, please explain.
3. Have you ever fainted, felt dizzy, or unusually winded after exercise?
Yes
No
If yes, please explain.
4. Has a doctor said that your blood pressure is too high or uncontrolled?
Yes
No
If yes, please explain.
5. Has a doctor ever said you have heart trouble, a heart murmur, or that you have had a heart attack?
Yes
No
If yes, please explain.
6. Are you diabetic, have a thyroid condition, or any chronic condition?
Yes
No
If yes, please explain.
7. Are you using any medications? List Them
Yes
No
If yes, please explain.
8. Is your cholesterol level high? What's your cholesterol count?
Yes
No
If yes, please explain.
9. Do you have any condition that a doctor says may limit your exercise?
Yes
No
If yes, please explain
10. Have you had surgery in last 12 months?
Yes
No
If yes, please explain
Your Athletic History:
1. List your favorite sports and years of participation
2. Do you currently have a strength training routine? If yes, please briefly describe.
3. Have you ever had an exercise related injury which caused you to stop exercising for a week or more? If yes, please describe.
4. For multisport and running, list your best race times, with splits if possible. Cyclists and MTBers list race category and years at that category.
Your Current Athletic Information
1. Have you planned what races you will compete in for next season? If so, please list with dates and priority (A, B, or C, A being most important)
2. What are your three most important goals? Rank them 1-2-3.
3. At the completion of our first season together, how will we know if we were successful? What is the single most important thing we must accomplish?
4. What is your training week like currently. Please list type of workout, length of workout, and intensity of workout.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
5. What is your longest workout in the last 3 weeks? Describe.
6. What time of day do you expect to do most of your training during the work week?
7. Multisport and/or Cycling: Brand/Model of bike. Was bike professionally fit?
8. Multisport and/or Cycling: Do you have a bike trainer?
Yes
No
9. Multisport/Running. Do you have access to a track?
Yes
No
10. Do you ever train with a group or participate in group classes? Please list days and times.
11. Multisport only: Do you have access to a pool? What size? Days you prefer to swim?
12. Multisport only: Do you have acess to a masters swimming program and if so days please list day of workouts.
13. Which day is best for you to take off from training?
14. What were the most important races you did in the last 12 months
15. Do you own a heart rate monitor or GPS watch?
No
Heart rate monitor
GPS with heart rate
16. How familiar are you with training with a heart rate monitor?
Select
Not familiar at all
Some what familiar
Very familiar
17. Do you own a Computrainer or other power meter device? Please list devices.
18. Do you know your lactate threshold heart rate for any sport? Please list and describe how it was determined.
Bike
Run
Other
Limiters:
Time to train
Select
Poor
Good
Excellent
History of Injuries
Select
Poor
Good
Excellent
Body Strength
Select
Poor
Good
Excellent
Flexability
Select
Poor
Good
Excellent
Mental Skills
Select
Poor
Good
Excellent
Nutrition
Select
Poor
Good
Excellent
Comments or Questions:
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