Roeder Multisport Athlete Background Information Questionnaire

Athlete Background

Please fill in as much detail as possible.
Name

First NameLast Name
Phone Number*

Area CodePhone Number
Occupation*
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home phone

Area CodePhone Number
Work phone

Area CodePhone Number
General Medical History
Significant Medical History (surgery, injuries, serious illness):
Anything that could impact training
Please list any current illness, recent injuries, recent surgeries, or past medical problems or surgery of note. (asthma, seizures, headaches):
Height:
Weight:
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 your were, and any other comments.
2. List your best (or favorite) race results, events, times, place, conditions, and so on.
3. On average, how many miles or hours per week did you train in the last year?
4. 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?
5. What do you feel are your strengths and weakness as an endurance athlete?
Current Training Level Information
Primary race distance(s) *
What is your resting heart rate?
1. What’s the highest heart rate you’ve had while Running?
What’s the highest heart rate you’ve had while Swimming?
What’s the highest heart rate you’ve had while Biking?
Rate your current fitness level 1-5 (5 being the best, 1 being the worst) compared to your highest level in the past five years.
Describe your current training week. If you keep a training log include a copy of your last week.
Is this more, less, or the same as a normal training week for you?
Describe your longest single workout in the last three weeks:
Are you currently recovering from any injury or illness? Explain:
RACING AND PERFORMANCE GOALS
List below all the events you plan on possibly competing in this year. We understand this schedule is subject to change. Please list all swim, bike, and run events *
HIGH PRIORITY EVENTS (A RACES): 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.*
Date Event Distance(s) Goal Time / Place
In a year's time what athletic related goals are you looking to achieve?*
EQUIPMENT AND OTHER INFORMATION
Do you own a smart watch (Garmin, apple, etc.) to track workouts?
What is the make and model
Do you have access to the following

PoolTreadmillTrack (outdoor)Track (indoor)BikeStationary bikeElliptical or Arc MachineWeight RoomOpen Water SwimmingBike ComputerGarmin ConnectTrainingPeaks Account
Do you own or plan to purchase any of the following

Smart WatchPower MeterSwim SkinProfessional Bike FitHeart Rate Monitor (Bike)Road BikeTriathlon BikeRace WheelsWetsuitHeart Rate Monitor (Run)
Training Availability
Please enter time available and preferences here. See example below. Leave blank if you are unsure or new to training. 

Monday- a.m. swim (45 minutes ) / p.m. run (60 minute )
Tuesday- a.m. bike
Wednesday - rest day
Thursday- a.m. swim (45 minutes) / p.m. run
Friday - a.m. bike
Saturday - long run
Sunday- long ride
Have you worked with a running and/or triathlon coach before? If so, what did you like about it and what would you change. You do not need to share coach or club names, just overview.
What are your most important priorities when looking for a coach?
Hows per week available to train?
Anything else you would like to share that would be helpful for coach to know to help you in your process?
How did you hear about us?
Should be Empty:

Athlete Background

General Medical History

Current Training Level Information

RACING AND PERFORMANCE GOALS

EQUIPMENT AND OTHER INFORMATION