Athlete History Questionnaire
Please read thoroughly and fill out all required fields and sign
Name
*
First Name
Last Name
Email Address (Please use primary email address)
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthdate
*
-
Month
-
Day
Year
Phone Number
*
Please enter a valid phone number.
Emergency Contact Name
*
Emergency Contact Number
*
Please enter a valid phone number.
Height
Weight
Resting Heart Rate
Resting Blood Pressure
Medical Conditions/ Chronic Conditions
*
Medications
Allergies
Injuries and/or Surgeries
Any Health Issues That May Affect Training
Athletic Background
Have you played any coached sports before? Please elaborate.
Have you had a Triathlon coach before? If yes, please elaborate what ended the relationship.
Please list bellow any triathlon races you have done, with your finishing times if possible.
How often do you swim and for how long each time?
Do you own a wetsuit and open water swim buoy?
Are you comfortable with open water swimming? If not, please explain your challenges.
Do you own a bike? Is it a road or Tri bike?
Are you comfortable clipping on your bike?
Do you own a smart trainer?
Are you comfortable in the aero position?
How often do you ride ? And how for how long each session outdoors ? How long your average indoor sessions?
How often do you run? And for how long?
Do you own a treadmill?
Do you own any strength equipment?
Do you do any form of strength training?
Please describe your level of fitness in the following categories:
Muscular strength
Excellent
Good
I don't do strength training
Cardiovascular strength
Excellent
Good
I don't do any cardio fitness
Flexibility
Excellent
Good
I don't stretch or do any flexibility exercises
Please indicate the number of hours you will commit to training:
Available number of hours in the AM
Available number of hours in the PM
Available number of hours in the on Saturdays
Available number of hours in the on Sundays
Races -
Did you do or sign up for any races this year or next year? If yes, please list them bellow.
List your races:
Goals:
Please list your goals below:
When are you ready to start?
Signature
*
Submit
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