Pre-Screening Questionnaire

Sports Performance Pre-Screening Questionnaire
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
T-Shirt Size
Sport(s)
Positions
Have you been in a strength training program before?

YesNo
If yes, when and how long was the program?
Have you ever squatted before?

YesNo
If yes, do you know your PR?
Have you ever bench pressed before?

YesNo
If yes, do you know your PR?
How many years have you been playing your sport?
How many hours a week do you play your sport?
How many months out of the year do you play your sport?
Does your sports coach have your do strength training?
Do you have any previous injuries?

YesNo
If yes, list any injury/injuries and date of onset. Please be specific on side of the body and if any treatment was provided.
Any previous surgeries?

YesNo
If yes, please list the procedure and date
List any health conditions you have had or currently have
Any current injuries or pain?

YesNo
If yes, please explain:
Are you taking any medications or supplements?

YesNo
If yes, please list:
How many hours of sleep do you get per night?
Do you eat 3 meals a day?

YesNo
Do you feel like you eat enough during the day?

YesNo
Have you started your period?

YesNo
If yes, at what age was your first period?
If yes, do you have a monthly, regular period?
List 3 goals you have to accomplish through Dr. Doc's strength and conditioning program:
List 2 strengths of your sport or athletic ability:
List 2 areas of improvement for your sport or athletic ability:
What is your long term goal for you high school sports career?
List 2 activities you like to do outside of your sport?
Who is your favorite college or professional athlete and why?
Should be Empty:

Sports Performance Pre-Screening Questionnaire