Name
*
First Name
Last Name
Email
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Date of Birth
*
MM
DD
YYYY
How does your family support your goals and objectives?
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While we like to think we are individuals, we all need a little support.
Likes/Dislikes
List your past and current athletic activities.
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Example: Walks, Runs, Swimming, Cycling, Hiking etc….
Are you open to joining a workout facility?
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Yes
No
Do you have a workout facility at home?
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Yes
No
If you do have a workout facility at home, what equipment do you have available?
How many hours can you dedicate to your training per week?
How often do you travel?
Do you have access to training facilities when you travel?
What type of equipment do you have at this time? (Gear for swimming, cycling, running etc….) Do you have any questions or concerns about the equipment you are currently using?
Do you have the proper gear for the sport or sports you plan on participating in?
Do you have any medical issues or concerns?
Is there anything else I should be aware of when designing your program?
What software are you currently using to keep track of your training?
Are you currently participating in a strength development program?
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Yes
No
What is your 3 months, 6 months, 1 – 3 – 5 years and beyond Goals?
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What are your athletic goals? When do you plan on accomplishing your athletic goals?
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What are your professional goals? When do you plan on accomplishing your professional goals?
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What are your personal goals? When do you plan on accomplishing your personal goals?
Have you been injured in the past? Are you injured now?
Do you have any concerns about being able to do certain kinds of movements or exercises?
What are your dietary issues or concerns?
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Are you currently seeing a physician and have you been cleared to workout?
How do you like to be coached?
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Please give at least two examples.
How do you not like to be coached?
*
Please give at least two examples
Are you a type “A” person? 2 X “A” person? I’ll explain when we visit.
What type of athlete are you or want to be? Do you want to compete or complete?
Are you able to stick to a plan?
Do you understand that there will be high points and low points along the way?
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Yes
No
Are you familiar with the periodization phases of training?
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Yes
No
