Please fill out the following form.
The following questionnaires are required to begin a training program at any degree. The information you provide is kept in the strictest confidence and will never be shared with a third party. The information will be used solely in determining your level of current fitness, experience and history and other factors that will be analyzed to determine the appropriate training program for each individual exclusively.

Any questions pertaining to the information requested should be directed to the Coach.

Personal Information & Assessment (or print and bring with you)

First Name:

Last Name:

Address:

City:

State:

Zip:

Cell Phone:

Home Phone:

E-Mail:


Medical History

List any prescriptions you are taking currently or have taken in the past.


List any surgeries or any traumatic injuries.

List anything I may need to know concerning medical history.

Athletic History

List any prior sports endeavors:

Describe your current fitness level.


Goals

Top 3 goals for this year.

Top 3 goals for the next 5 years:

Lifestyle

How many hours are you currently training?

Give me an idea of your weekly schedule. Do you need or want a specific day off each week?

How many hours per week can you train?

Open discussion (This is where you tell me about yourself. Family, career, pets, etc..)
© 2009 Multisport Coaching Systems