Sports Performance Pre-Screening Questionnaire
Full Name
First Name
Last Name
Date of Birth
Please select a month
January
February
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December
Month
Please select a day
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Day
Please select a year
2024
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Year
Age
years
Height
cm
Weight
KG
T-Shirt Size
Sport(s)
Positions
Have you been in a strength training program before?
Yes
No
If yes, when and how long was the program?
Have you ever squatted before?
Yes
No
If yes, do you know your PR?
Have you ever bench pressed before?
Yes
No
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?
Yes
No
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?
Yes
No
If yes, please list the procedure and date
List any health conditions you have had or currently have
Any current injuries or pain?
Yes
No
If yes, please explain:
Are you taking any medications or supplements?
Yes
No
If yes, please list:
How many hours of sleep do you get per night?
Do you eat 3 meals a day?
Yes
No
Do you feel like you eat enough during the day?
Yes
No
Have you started your period?
Yes
No
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?
Submit
Should be Empty: