GAMESPEED Athlete Intake & Performance Assessment

GAMESPEED Athlete Intake & Performance Assessment

Professional intake and performance assessment for high-school athletes and parents.
Athlete Information
Athlete First Name
Athlete Last Name
Athlete Email
example@example.com
Athlete Phone
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade
City
Emergency Contact
Emergency Contact Name

First NameLast Name
Relationship to Athlete
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email
example@example.com
Sports Background
Primary sport
Position / event
Competitive level
Years playing primary sport
Other sports played

Other
Previous speed training?
If yes, briefly describe previous speed training
Previous strength/conditioning training?
If yes, briefly describe previous strength/conditioning training
Practices/games per week
Current Training
Are you currently strength training?
If yes, how many days per week do you strength train?
Are you currently doing speed and agility training?
If yes, how many days per week do you do speed and agility training?
Are you currently doing conditioning?
If yes, how many days per week do you do conditioning?
Total training and sport days per week
Injury & Medical History
Do you currently have any pain, injury, or physical limitation that could affect training or testing?
If yes, please describe the pain, injury, or physical limitation.
Have you had any previous significant sports injuries?
If yes, please describe the previous sports injuries.
Have you had any previous surgery?
If yes, please describe the surgery or surgeries.
Have you had a previous concussion?
If yes, please provide details about the concussion.
Are you currently receiving any treatment or rehabilitation?
If yes, please describe the treatment or rehabilitation.
Is there any other medical information GAMESPEED should know before testing?
Goals
What is the #1 thing you want to improve?
Specific performance goal
Appointment
How would becoming faster or more explosive help your sport performance?
What would make GAMESPEED training successful for you?
Any other goals or information your coach should know
Assessment Readiness
Did you have a game, practice, or workout within the last 24 hours?
If yes, please describe
Current physical condition
Current soreness location

Other
Final
How did you hear about GAMESPEED?
Anything else we should know
Name of person completing this form

First NameMiddle NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

GAMESPEED Athlete Intake & Performance Assessment

Athlete Information

Emergency Contact

Sports Background

Current Training

Injury & Medical History

Goals

Assessment Readiness

Final