Sub17 Multisport

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Athlete Questionnaire

Contact Information

Contact Information

Name:

Email:

Cell:

Address:

Contact preference:

Emergency contact name:

Emergency contact phone:

Free Text

Medical History

Date of birth:

Gender:

Height:

Weight:

Is this your normal weight?

Resting heart rate:

Resting blood pressure:

Conditions/Chronic diseases:

Other Conditions/Chronic Diseases

Cardiovascular Medical History

Cardiovascular medical history

Do you feel pain in the chest when performing physical activity?

Do you suffer from high or low blood pressure?

Are you taking medication to control your blood pressure or a heart condition?

Do you have a back/joint problem that could be made worse through physical activity?

Do you knowingly suffer from diabetes?

Do you suffer from respiratory illness (asthma, bronchitis, emphysema) or have shortness of breath with mild exertion?

Are you under medical treatment for any illness?

Females only: Are you pregnant or have you had a child in the last 3 months?

Medications:

Injuries (bones, joints, muscle) and/or surgeries:

Treatment for injuries:

What aggravates your injuries?

Any (safety) issues that would affect training program?

History of medical issues during exercies:

Lifestyle

Lifestyle

Work:

Family:

Hobbies:

Work related travel:

Number of hours/week exercising?

Preferred time of day exercising?

Access to pool/open water?

Access to biking (outdoor/indoor)?

Access to running (outdoor/indoor)?

Exercise Availability

Exercise Availability

Monday

Time Available:

Type:

Tuesday

Time Available:

Type:

Wednesday

Time Available

Type:

Thursday

Time Available

Type:

Friday

Time:

Type:

Saturday

Time

Type

Sunday

Time:

Type:

Dietary

Number of meals/day

Calorie intake (if known):

Diet/Restrictions:

Dietary supplements (vitamins, herbs, minerals, protein, replacements):

Psychological:

Psychological:

Self awareness:

Level of confidence to complete the race:

Ability to set goals and target:

Ability to follow through with goals:

Use of visualization/imagery to prepare for a race:

Use of self-talk/thought control:

Ability to pay attention/focus under stress:

Grit:

Ability to excel under pressure:

Ability to make decisions under stress:

Consistency:

Ability to take recovery days without guilt:

Triathlon History

Triathlon History

Triathlons completed:

Number of triathlons completed:

Longest distance completed:

Running events:

Bike events:

Triathlon goals:

Swimming

Swimming

Years swimming:

Average weekly distance:

Weekly frequency:

Longest swim:

Swim confidence

What do you think are your limiters?

What do you think are your strengths?

What equipment do you own?

Access to pool/open water?

Biking

Biking

Years biking:

Average weekly distance:

Weekly frequency:

Longest bike:

Do you use cycling apps?

Do you own a smart trainer?

Bike:

What do you think are your limiters?

What do you think are your strengths?

What equipment do you own?

Access to riding:

Do you ride in a group?

Running

Running

Years running:

Total weekly distance:

Weekly frequency:

Longest run:

What do you think are your limiters?

What do you think are your strengths?

What equipment do you own?

Access to a treadmill?

Strengh and Conditioning

Strength and Conditioning

Which of the following types of equipment do you have access to?

Does your occupation require extended periods of sitting or driving?

Does your occupation require you to wear shoes with a heel (dress shoes)?

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CONTACT

sub17multisport@gmail.com
214-940-2408

CONNECT

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Athlete Questionnaire

Athlete Questionnaire

CONTACT

sub17multisport@gmail.com214-940-2408

CONNECT

sub17multisport@gmail.com
214-940-2408