Personal
Emergency Contact
Name:
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Home Phone:
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Cell Phone:
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Mailing Address
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Email Address:
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Date of Birth:
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Date of Birth
Preferred Contact #:
Email Address:
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Medical and Health
Have you ever suffered from any medical ailments? Such as Heart Attack, stroke, emphysema, obesity, diabetes, asthma, fibromyalgia, arthritis, chronic back pain, tuberculosis, or other?
Do you have a family history of any of the above medical ailments? Please list all that apply.
Currently, are you taking any medication?
Do you have any food allergies?
Do you have any other information you would like to disclose so we may support you?
Exposure
Why have you considered Tranter Triathlon Coaching?
How did you first learn about Tranter Triathlon Coaching?
Why have you considered Rob Tranter as your Coach?
Have you ever participated in an exercise program before?
Have you ever completed a training program of 6 consecutive months?
Have you ever participated in a race or an event?
Did you complete any one or more of the above events in the last 12 months?
Do you have any interest in participating in any of the above events? Which ones?
What is/are your preferred sport(s) to build your fitness?
Injury History
Do you currently have any injuries, aches, pains or physically limiting ailments?
What previous injuries have affected your training and/or health?
Have you ever been treated by a registered chiropractor, physiotherapist, massage therapist or athletic trainer?
Holistic Health History
Do you incorporate any form of strength training in your lifestyle?
Do you incorporate any form of static stretching before or after exercise?
Do you incorporate dynamic stretching and/or neuro-muscular activation prior to training or racing (hopping, bounding, limb swinging, accelerations, wind sprints, jumping etc.)?
Do you incorporate any psychological skills training, meditation or mindfulness practice in your lifestyle?
Do you have any specific education in the sport/health sciences?
On a scale from 1 – 5 (1= poor, 5= optimal) how would you rate your daily eating habits?
Where could your eating habits improve? Please select all that apply:
Options: portion control, limiting salt or sugar intake, timing of meals, increasing fruits and/or vegetable portions, increasing vegetable protein (beans, legumes, nuts/seeds etc), increasing lean meats and eggs, increasing clear fluids, increasing dairy products, increasing whole grains, other.
ATHLETIC TRAINING QUESTIONS
Current Training
How many weekly training hours do you consistently plan to complete?
How many weekly training hours do you currently complete?
On a scale from 1 – 5 (1 = poor, 5 = optimal), how would you rate your time management?
What time of day do you prefer to exercise?
What is the best day in your schedule for intense (short duration) exercise
What is the best day in your schedule for long duration (low intensity) exercise?
Training History
Please indicate the largest volume (total accumulated hours) training week you have completed in the last year.
Please indicate the largest volume (total accumulated hours) training week you have completed in the last month.
less than 3 3 – 6 6 – 9 9 – 12 12 – 15 over 15
Do you try to evenly distribute your total training hours across several sports?
Do you vary the proportion of sport specific training depending on time management, the season and/or work/family commitments?
Have you or a coach/trainer ever used T.S.S. (training stress score) to quantify stress in your lifestyle and training?
Have you ever been videotaped under water to help assess your swim stroke?
Have you ever been professionally fit on your current bike?
What has been your longest run in the past 3 months?
What has been your longest bike in the past 3 months?
Goals for 2013
Short-term (3 months or less) 1)
Long-term (over 3 months)
