General/Medical
Name:
Address:
E-mail:
Phone: Best # to reach you:
Emergency Contact (name): (phone):
Birthday (mm/dd/yy): / / Height (inches): Weight (lbs):
Body Fat %: Resting heart rate: Blood pressure:
Please list all muscular skeletal injuries you have experienced (type, date, treatment);
Medical Conditions:
Surgery in past year (type, date, treatment):
Do you have any condition that will limit high intensity exercises?
Medications and supplements you are taking:
Last physical exam (mm/dd/yy): / /
What sport(s) are you seeking coaching for?
What are your secondary events and format?
Do you have a specific performance goal this season?
What is your dream goal (i.e. complete an Ironman, marathon, ultra, etc)?
How many races did you compete in last year?
Why do you compete?
Describe your strengths as an athlete
Describe your weaknesses as an athelete
Rate the following with the selection that best describes you (Poor, Good, Excellent)
