| 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?* |
|
