|
BASIC |
|
| * |
Name
|
|
| * |
Address |
|
| * |
City
|
|
| * |
State
|
|
| * |
|
|
| * |
Country |
|
| * |
E-Mail
|
|
| * |
Home Phone |
|
| * |
Work Phone |
|
|
Fax |
|
|
Pager |
|
|
Cell Phone |
|
|
|
|
| * |
Gender
|
|
|
|
|
| * |
Birthdate
|
|
|
|
COMPUTER |
|
|
Operating System |
|
|
Email Application |
|
|
Word Processer |
|
|
Spreadsheet |
|
|
| * |
I would prefer to receive my training schedules by the following method: |
| |
Please choose: |
|
|
|
PERSONAL |
|
|
Occupation |
|
|
Hours Per Week |
|
|
Stress Level |
|
|
Marital Status |
|
|
How many children? |
|
|
Their ages? |
|
|
|
ATHLETIC |
|
|
|
|
|
Years training? |
|
|
Which sports? |
|
|
|
|
|
Years competing? |
|
|
Which sports? |
|
|
|
|
|
Best Races, times? |
|
|
|
|
|
Any other accomplishments you would like me to know about: |
|
|
|
|
CURRENT FITNESS
|
|
|
|
|
Rate your current fitness(1=worst shape 10=best shape)? |
|
|
|
|
Do you know your maximum heart rate, anearobic threshold, VO2 Max, etc? |
|
|
|
|
|
|
|
Do you know the above from Stress Test, Race, Lactate Test, etc.? Select all that apply. |
|
|
|
|
|
|
|
If you train with a heart rate monitor, which make/model do you use? |
|
|
|
|
If you train with a power measuring device for cycling, which make/model do you use? |
|
|
|
|
|
PHYSICAL PROFILE
|
|
|
|
Check all that apply to you |
|
|
|
|
I prefer the toughest conditions a race can throw at me. |
|
I can squat or leg press more weight than most athletes my size. |
|
I have always been physically stronger than other athletes. |
|
I prefer hilly courses. |
|
I am good at sprinting. |
|
I can easily bike and/or run at very high cadences. |
|
I have always been best at short, quick and/or explosive activities. |
|
I prefer short fast workouts and/or races. |
|
I have always been able to finish stronger than others regardless of sport. |
|
I am confident that I will not "bonk" in long workouts or races. |
|
I feel stronger at the end of long workouts than when I start. |
|
I prefer long races and/or workouts. |
|
|
|
MENTAL PROFILE
|
|
|
|
|
Do you consider yourself to be (please check one):
highly motivated fairly motivated not motivated |
|
|
|
|
Do you consider yourself to be (please check one):
very confident fairly confident lacking confidence |
|
|
|
|
Do you believe you have the ability to be (please check one:
very focused fairly focused not focused at all |
|
|
|
|
Assign the appropriate number to each of the statements below. |
|
1=Rarely 2=Occasionally 3=Often 4=Always |
|
|
|
|
I believe I have great potential as an athlete. |
|
I believe I am very successful at the things I put my mind to. |
|
I can race close to or above my ability level. |
|
I am mentally tough. |
|
I don't lose my confidence after I have a bad race. |
|
I love to train and rarely miss a planned workout. |
|
I am fired up on the morning of a race. |
|
I am willing to make sacrifices to achieve my goals. |
|
I set very high goals for myself. |
|
I try to be the best I can possibly be. |
|
I stay positive even when things go wrong. |
|
I am positive and pumped up before races. |
|
I learn from all of my races - good and bad. |
|
The harder the race the better. |
|
I can relax before races. |
|
I have no self-doubts before races. |
|
I have no problem staying focused during races. |
|
I am very in touch with my real and perceived effort during races. |
|
I can block out distractions during races. |
|
I concentrate best when the race gets hard. |
|
I can imagine myself doing well in the hardest races |
|
I can visualize handling tough race situations. |
|
I can see myself training and racing in my mind |
|
I mentally rehearse strategy, skills and possible race scenarios before races. |
|
I can visualize doing well in the big races |
|
|
|
|
|
Please list your greatest strengths (mental and/or physical): |
|
|
|
|
|
|
|
Please list your greatest weaknesses (mental and/or physical): |
|
|
|
|
|
|
|
MEDICAL INFORMATION |
|
|
|
Weight (lbs)
|
Are you currently under the care of a physician? If yes, explain. |
|
Ideal Weight (lbs)
|
|
|
Height (inches)
|
Are you taking any medication? If yes, please list |
|
%Body Fat
|
|
|
|
Have you had complete physical in the last year? |
|
|
|
|
|
Smoke? Never Quit Over a year ago Quit less than a year ago Currently Smoke |
|
|
|
|
|
Please check all of the following that apply to you. |
|
|
|
|
|
Have you or anyone in your family had coronary artery disease? |
|
|
|
|
|
Have you ever fainted or felt dizzy after exercise? |
|
|
|
|
|
Has a doctor said that your blood pressure is too high? |
|
|
|
|
|
Do you have heart trouble, a heart murrmur or have you had a heart attack? |
|
|
|
|
|
Do you ever have chest, shoulder, neck or arm pains during exercise? |
|
|
|
|
|
Are you diabetic, have a thyroid or any other chronic condition? |
|
|
|
|
|
Is your cholesterol level high? |
|
|
|
|
|
Are you now or have you been pregnant during the last three months? |
|
|
|
|
|
Do you have any conditions that your doctor says may limit your physical activity? |
|
|
|
|
|
Do you have any conditions that you think may limit your physical activity? |
|
|
|
|
|
Please consult your physician before starting this or any exercise or training program. |
|
|
|
|
|
|
|
YOUR CURRENT SCHEDULE |
|
|
|
|
|
|
|
How much time (hr:min) do you have available to train? |
Enter Total available for an average week
|
|
|
|
|
What time do you need to be done training in the morning to get to work on time? |
|
|
|
|
What time do you get home from work? |
|
|
|
|
What time do you typically go to sleep at night? |
|
|
|
|
What is your longest training session during the past month? |
|
|
|
|
|
Over the past two months what is the average number hours/week you trained? |
|
|
|
|
|
Can you vary your training time? Or do need to train the same hours each week?
(Explain) |
|
|
|
|
|
Are there any regular group workouts that you participate in? If so, please list and describe the workouts as accurately as you can (I.e.,time, intensity, time of day, sport, how many people,) |
|
|
|
|
|
When can you swim? |
|
|
|
|
|
|
Please give an idea of your typical training week, include AM, PM, Times, workout detail, etc. |
|
|
|
|
MONDAY
|
|
|
TUESDAY
|
|
|
WEDNESDAY
|
|
|
THURSDAY
|
|
|
FRIDAY
|
|
|
SATURDAY
|
|
|
SUNDAY
|
|
|
|
|
|
|
|
|
|
