Name
First Name
Last Name
D.O.B
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: 0000000000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Height (cm)
Weight (kg)
Do you currently play any sports? If so, what position and level/division do you play?
What would you consider your strengths in your sport/position?
What would you consider your weaknesses in your sport/position?
Do you have any injuries?
What are your performance concerns?
What is your exercise history/current training?
What are the obstacles limiting your performance?
Have you done Strength & Conditioning in the past? If so, what did it involve?
Have you done a performance assessment in the past? Would you be willing to share your results?
What would you like to get out of the performance assessment?
If you menstruate, is your cycle regular?
Yes
No
Not Applicable
What is your primary goal for the next 3 months?
What is your primary goal for the next 12 months?
Do you have any dietary conditions or health issues?
What does an average day of eating look like for you?
What's your biggest struggle with your diet?
Do you have a day/time preference?
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