Intake Form
Date
Full Name
Phone
*
Email
*
Address
Street Address
City
State
Country
Enter your country
Postal Code
Relationship Status
Date of birth
Children
Goals
What is your ultimate health and fitness/athletic outcome (NO LIMITS?) i.e. In 3-5 years time, how would you ideally like to describe your body, physical vitality and performance level?
How important (on a scale of 1-10) is your fitness/athletic goal?
What do you stand to gain by achieving this outcome? How will it affect the rest of your life (work, family, relationships, self-esteem)?
What ARE your top 3 outcome goals for the next 12 months?
Outcome 1
Outcome 2
Outcome 3
What WERE your top 3 goals at this time last year?
Outcome 1
Outcome 2
Outcome 3
Did you achieve them? Why? Why not?
Lifestyle
Please Elaborate
Hours you work per week
Rate your work stress level
What is Limiting you from achieving your goals? Please choose as many as apply and explain in the section beside.
Work Time
Family Commitments
Travel Time
Support Injury
Motivation
Knowlege/No Plan
Procrastination
Funds
Other
Schedule
Please provide us an outline of your current training schedule. Be as detailed or opened ended as necessary to help us understand how to structure your week. Mention if any sessions are coached or with groups.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What else would you like to know about your potential training schedule?
Training
Two greatest STRENGTHS in Triathlon
Strength
Strenth
Two greatest LIMITERS in Triathlon
Limiter
Limiter
Last 2-3 Months
For each of the following, what is the longest that you've been capable of doing ever and in the last 2-3 months and how long ago? I ask this so I can start your training off at a level that meshes with your present abilities.
Swim Session (in meters or yards)
Bike ride (kilometers/hours)
Run (kilometers/hours)
Bricks - bike/run (in hours)
Please list your swim intervals for an average workout.
For example, 100's on the 1:40 (touch on the 1:35)
100's
200's
400's
Do you train with a Power Meter?
If Yes, please specify the model
Yes
No
Do you train with a Heart Rate Monitor?
If Yes, please specify the model
Yes
No
Do you train with cadence on your bike?
Please specify
Yes
No
Coaching
Past sporting history
Anything that is relavant for us to know
Past coaching experience (list)
What worked well in those relationships?
What was less successful?
Injuries/Medical
Past History of Injury
Current Injuries
Do you see a Physical Therapist, Massage Therapist, Chiropractor on a regular basis? If so, are there any chronic injuries requiring such treatments?
Any other medical conditions that we should be aware of?
Do you have clearance from your Doctor to participate in a training program?
NOTE: If not, please obtain clearance before following any of the training programs provided by us.
Past Performance & Current Ability
Past race results for the past 3 years (comments if any)
Race Detals
Race
Date
Result
Comments
Race Detals
Race
Date
Result
Comments
Race Detals
Race
Date
Result
Comments
Race Detals
Race
Date
Result
Comments
Current Planned Races for This and Last Year (A, B, C)
Race Detals
Race
Date
Priority (A, B, C)
Goals
Race Detals
Race
Date
Priority (A, B, C)
Goals
Race Detals
Race
Date
Priority (A, B, C)
Goals