Making a difference to how you look and how you feel
     

Ready To Begin

All fields marked with a * are required:

Name*
Date of birth
Address
Phone
Email*
Occupation

Medical information

List any supplements:
Previous medical conditions
Angina / chest tightness with exertion Yes No
Heart attack Yes No
Heart murmur Yes No
Palpitations/irregular heart beat Yes No
High blood pressure Yes No
High cholesterol Yes No
Any family history of the above Yes No
Stroke Yes No
Dizziness, light headed or passed out during or after exercise Yes No
Bronchitis / Asthma / Wheezing Yes No
Joint problems limiting activity / exercise Yes No
Diabetes Yes No
Allergies Yes No
Are you currently taking any medication Yes No
Any other medical problem Yes No
If you answered yes to any of the above please give a more detailed explanation:

Training information

What is your sport?
Why do you want a coach?
What are your specific goals?
What is your maximum number of hours available to train per week?
What other commitments do you have eg family?
Where do you think your strengths are?
Do you know of any weaknesses you would like to work on?
If you are currently training at the present please indicate your current typical week of training:
What hours do you work each week ie please indicate your working hours?
Do you have a particular weekly session at a fixed time that you wish to participate?
Is there a particular day that suits you best for a recovery / rest day?
In the next few months have you any holidays planned or travel that may restrict or allow extra training?
Do you know the dates of some of the events that you wish to participate in over the next 12 months?
What do you consider a big week in terms of hours or milage in training?
What time of the day do you normally train?
Please detail any other information that you think will be helpful for us to know in the preparation of your training programme:
What is your preferred method of contact?*

Ph: Gayle 09 521 6500 E: gayle@bodywise.org.nz

Ph: Jenny 0274 780 272 E: jenny@bodywise.org.nz