Athlete Questionnaire for Coaching Name *Preferred Name Address *City *State *Phone *Email *What are the best times to reach you? *Birthday Age Hieght Weight Occupation Hours/Week Married? - Select One -YesNoChildren? - Select One -YesNoHow did you hear about these coaching services? Please check if your answer is "Yes" then explain below. Has a doctor ever said that you have a heart condition and recommend only medically supervised physical activity?Do you have chest pain brought on by physical activity?Have you developed chest pain within the last month?Do you ever lose consciousness or fall over as a result of dizziness?Do you have a bone or joint problem that could be aggravated by the proposed physical activity?Has a doctor ever recommended medication for high blood pressure or a heart condition?Are you aware, through your own experience or a doctor’s advice, of any other physical reasons against your exercising without medical supervision?Explain Other Health History Questions Do you have any metabolic diseases, controlled or uncontrolled? Examples are diabetes, hyperthyroidism, hypothyroidism, etc.Do you, or have you ever, smoked regularly?Do you take any drugs or medications?Are you, or have you been, recently pregnant?Do you have or have you had high cholesterol?Have you had any surgery in the past year?Have you ever had an injury that caused you to stop exercising for more than one week?Do you have or have you had an eating disorder?Are there any other physical or emotional problems that may affect your training?Explain ATHLETIC HISTORY: 1. Please list the sports and activities in which you have participated most often throughout your life. Include duration participated, how long ago, how competitive you were, and any other comments. 2. List your best (or favorite) race results - events, times, place, conditions, etc. 3. On average, how many miles or hours per week did you train in the past year? 4. Have you ever done any strength / resistance training? - Select One -YesNo4a. Do you think it helped your performance? - Select One -YesNo5. Do you feel you have ever “overtrained”? If yes, please describe the type and amounts of training you were doing at the time. 6. Do you have any chronic injuries from any sport or activity that may flare up or should be taken into consideration in developing your training plan? 7. What do you feel are your strengths and weakness as an endurance athlete? CURRENT FITNESS LEVEL INFORMATION: 1. What is your waking pulse (beats per minute)? 1a. Is this high or low for you? - Select One -HighLowDon't know2. Select what you feel is your current fitness level compared to your highest fitness level in the past 5 years. (1=high, 5=low) - Select One -1 - low2345 - high3. Describe your current training week. If you keep a training log, include a copy of last week: 4. Is this more, less or the same as a normal training week for you. MoreLessSame5. Describe your longest single workout in the last three weeks. 6. How many hours per week do you spend training now? 7. Please list exactly when and how much time you have available for training (include morning and evening training available time if possible) 8. How many days per week do you take off from training? 9. Are you currently recovering from any injury or illness? Explain: 8a. Ideally, how many days would you like to take off from training? EQUIPMENT AND OTHER INFORMATION: 1. Do you own a heart rate monitor? YesNo1a. If so, what brand and model? 2. What is the highest heart rate you have noticed while running? 2a. During cycling? 2b. During another sport? 3. Please check off the equipment that you own or have access to: Bike Computer (list features below)Free WeightsLonger, moderate grade hillMountain Bike Nautilus Type WeightsNordic TrackOpen WaterPoolResistance TrainerRoad BikeRoller BladesRowing ErgometerRunning Track (list below: 1 lap = ?)StairMaster / Stepper Steep, Short HillTreadmillTriathlon Bike Water Jog Vest3a. For bike computer, list the features. For running track, 1 lap = ? distance. 4. At the end of this month, how will you judge if your training program is working? 5. At the end of this season, how will you judge if this training program was successful? 6. Why do you train and compete in endurance sports (be honest)? RACING AND PERFORMANCE GOALS: 1. High Priority Events - These are the most important events of the racing season to you. There should be only a few of these because we will design your training schedule to taper and peak for them. 2. Medium Priority Events - These are events that you want to do well at, but are not the focus of your season. We may rest for these events, but usually they will be thought of as race pace “workouts” to sharpen up for the High Priority Events. 3. Low Priority Events - These are events of least importance to you. They are “fillers” to your season and you will most likely compete for fun and for a good workout. Do not include too many of these events, however, as they might detract from the focus of your season. S.M.A.R.T. GOALS: Season/Long Term Goal What will it take to achieve my goal? - Step 1 What will it take to achieve my goal? - Step 2 What will it take to achieve my goal? - Step 3 Short term goals that will help me achieve my season/long term goal: These can be daily training goals and/or competition goals. Submit
