Coaching Application

Coaching Application

Please fill out information as accurately as possible.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
E-mail*
Personal Information

This will help provide a lens into what your responsibilities and schedule will be to promote understanding of context for scheduling workouts.
Occupation*
When is your birthday?

MonthDayYear
Marital Status *
Height*
Weight*
Do you have any children?
Typical hours/week at work:*
Health History
Have you or anyone in your family had coronary artery disease?*

YesNo
Do you often feel faint or have spells of severe dizziness*

YesNo
Do you ever have chest, shoulder, neck, or arm pains after exercise?*

YesNo
Have you ever fainted, felt dizzy, or unusually winded after exercise?*

YesNo
Are you diabetic, have a thyroid condition, or any chronic condition?*

YesNo
If yes to any of the above, please explain.
Are you taking any medications?*

YesNo
If yes, please explain.
Is your cholesterol considered high?*

YesNo
Have you ever had a complete physical exam including stress test on a treadmill or ergometer?*

YesNo
If yes, please explain the results.
Do you have any condition that a doctor says may limit your exercise?*

YesNo
If yes, please explain.
Have you ever smoked?*

YesNo
If yes, when did you quit?
Have you had injuries in the past?*

YesNo
If yes, please explain.
Do you currently have any injuries that are impacting your ability to run?*

YesNo
If yes, please explain.
Bone Health Questions

Questions to gauge energy availability and bone health.
Have you had any bone or DEXA scans? If so, what were the relevant findings?

How would you rate your energy availability on a typical day?*

	1	2	3	4	5	6	7	8	9	10

1 is No Energy, 10 is High Energy

Females Only: Date of first period.

MonthDayYear
Date
Females Only: Date of most recent period.

MonthDayYear
Date
How many hours of sleep do you get per night?*
Please describe your typical fueling strategy.*
Ex: favorite fuel to take while running and amount, pre run meals, post run recovery meals, ect.
Feel free to add any additional relevant information on bone health/energy availability that would be helpful for context.
Athletic History
Please list your past sports participation and how long you participated in them.*
Do you currently utilize strength training as part of your cross training? Please explain.*
Current Training Information
Please list any planned races that you will be, or hope to compete in the next season and the date that they will occur.
A Race*
Date*

MonthDayYear
Date
B Race
B Race Date

MonthDayYear
Date
C Race
C Race Date

MonthDayYear
Date
D Race
D Race Date

MonthDayYear
Date
E Race
E Race Date

MonthDayYear
Date
What does your training consist of during a typical week?
Monday*
Tuesday*
Wednesday*
Thursday*
Friday*
Saturday*
Sunday*
How many hours per week do you have available to train?*

0-22-44-66-88-1010-1212-1414-1616-1820+
Which day(s) of the week are best to take off from training?*
What exercise/strength equipment do you currently have access to?*
Ex: treadmill, dumbbells, resistance bands, weighted vest, plyo boxes, barbell rack, pool, bike.
If you are aware, please list 10 rep max for the following key lifts : (Squat, Deadlift, Glute Thrust, Loaded Carry)*
Ex: Barbell Squat 145# for 5 repetition max.
Is there a time of day that you expect to do most of your training?
Do you own a gps watch? If so, what kind?*
Do you know your current HR max?*
Do you know your current resting HR?*
Do you know your current lactate threshold HR?*
What do you feel your current easy pace is?*
(Pace that you could easily hold a conversation at)
Please list your 5 5k PR and date:*
Please list your 10k PR and date:*
Please list your top 3 goals for training in order of importance.*
Please list your most recent half marathon, and your top 3 overall half marathon dates and times. (place n/a as needed)*
Please list your most recent marathon, and your top 3 overall marathon dates and times. (place n/a as needed)*
Communication

Regular communication will be a hallmark of this coaching approach. Messaging as well comments within the TrainingPeaks app will be utilized to allow for seamless communication for training updates and discussion.
What is the easiest way to stay in touch?*

Instagram MessengerFacebook MessengerEmailOther
Coaching Plans Review
Terms/Conditions and Signature
Today's Date*

MonthDayYear
Date
Signature indicates that you have read and agree to the terms and conditions and the information entered in this form is correct to the best of your knowledge.*

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After submitting your information, you will be directed to the payment page.
Link to Private Policy
Should be Empty:

Coaching Application

Personal Information

Health History

Bone Health Questions

Athletic History

Current Training Information

Communication

Coaching Plans Review

Terms/Conditions and Signature