| Basic Information: |
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| First Name:
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| Last Name:
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| Full Address:
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| How can I contact you:
Phone numbers:
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| Best time to reach you:
E-mail address:
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| Which Sport are you seeking coaching for:
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| How did you find out about Healthy Results :
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| What level of coaching are you currently
at?
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| If you are signing up for a Training Plan, what race are you gearing up for and what is the race date?:
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| When would you like to start your program?
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Non-Athletic Details: |
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| Occupation:
Hours worked weekly:
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| Married:
Spouse name:
Children:
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Your Health History: |
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| 1. Do you have, or has anyone in your family ever had coronary
artery disease?: |
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If yes please explain:
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| 2. Do you ever experience chest, shoulder, neck, or arm
pains after exercise?: |
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If yes please explain:
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| 3. Have you ever fainted, felt dizzy, or unusually winded
after exercise? |
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If yes please explain:
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| 4. Has a doctor said that your blood pressure is too high
or uncontrolled? |
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If yes please explain:
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5. Has a doctor ever said you have heart trouble, a heart
murmur,
or that you have had a heart attack? |
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If yes please explain:
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| 6. Are you diabetic, have a thyroid condition, or any chronic
condition? |
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If yes please explain:
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| 7. Are you using any medications? List Them |
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If yes, please list medications you are taking:
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| 8. Is your cholesterol level high? |
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If yes, what's your cholesterol count?
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9. Have you ever had a complete physical exam including
stress test
on a treadmill or ergometer? |
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When did you take the test (please include
copy of results):
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| 10. Do you have any condition that a doctor says may limit
your exercise? |
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If yes please explain:
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| 11. Have you ever smoked?: |
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When did you quit?:
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| 12. Have you ever had a joint or back disorder or any current
injury? |
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If yes please explain:
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| 13. Have you had surgery in last 12 months? |
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If yes please explain:
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| 14. Are you now, or have you been pregnant in last three
months? |
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If yes please explain:
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Your Athletic History |
1. List your favorite sports and years of participation.
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| 2. Do you currently have a strength training routine? |
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If yes, please describe (machines or free
weights, days per week, sets, reps, resistance, etc)
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3. Please rate your familiarity with strength
training routines
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4. Have you ever had an exercise related injury which caused
you to stop exercising for a week or more? |
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If yes. please provide details.
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5. For multisport and running, list your
best race times, with splits if possible.
Cyclists and MTBers list race category and years at that
category.
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Your Current Athletic Information |
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| 1. Have you planned what races you will compete in for next
season? |
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If so, please list with dates and priority
(A, B, or C, A being most important)
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2. What are your three most important goals?
Rank them 1-2-3.
Goal 1:
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Goal 2:
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Goal 3:
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3. At the completion of our first season
together, how will we know if we were successful?
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4. What is the single most important thing
we must accomplish?
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5a. What is your training week like now?
Please list Type of workout, How long & How hard |
| Monday workout:
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| Tuesday workout:
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| Wednesday workout:
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| Thursday workout:
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| Friday workout:
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| Saturday workout:
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| Sunday workout:
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5b. Is the above high, normal, or low for
you?
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| Please provide an example of a typical HIGH
VOLUME week from your training log.
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6. What is your longest workout in the last
3 weeks? Describe.
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| 7. How many weekly hours do you have available
to train? Be realistic
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8. What time of day do you expect to do most
of your training during the work week?
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9. Where do you plan to swim?
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10. When do you plan to swim?
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11. What size of pool?
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12. Do you have access to a masters swimming
program?
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13. What do you find most difficult part
of swimming?
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14. What is a long swim for you?
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15. Have you ever swum with pace times and
if so what are they?
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16. Additional information about swimming?
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17. Do you have a bike trainer?
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18. Have you ever trained with power?
If yes, what type of system have you used and what testing
have you done with wattage?
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19. Do you have a cycle computer with cadence
function?
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20. Do you have access to a running track?
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21. Do you ever run with a group?
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22. How often do you change you running shoes?
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23. How many times a week do you normally run?
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24. What is a LONG run for you right now? (hr:min:sec)
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25. Have you ever done any interval training?
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26. How many years have you been running?
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27. Do you have a treadmill you can use?
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28. Which day is best for you to take off from training?
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29. How many kilometers or hours did you train
in the past 12 months for each sport?
Swim:
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| Bike:
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| Run:
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30. What were the most important races you did in the last
12 months?
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31. Do you own a heart rate monitor?
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32. How familiar are you with training with a heart rate
monitor?
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33. Do you own a Computrainer or other power meter device?
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| 34. What is the highest heart rate you have observed during
exercise? |
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Which sport?
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| 35. Do you know your lactate threshold heart rate for any
sport? |
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Please list and describe how it was determined
Swim: |
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| Bike: |
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| Run: |
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Limiters
In order to focus your training most efficiently, we need
to determine your limiters: those aspects of fitness
that are limiting your current performances. Please take
a few moments to assess your abilities on a score of 1-5.
1 = among the worst in my race category
3 = about the same as others in my race category
5 = among the best in my race category
See descriptions of each ability below.
| Abilities/Techniques |
Swim |
Bike |
Run |
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| Endurance |
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| Force |
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| Speed Skills |
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| Muscular Endurance |
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| Anaerobic Endurance |
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| Power |
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Definitions:
Endurance is the ability to delay the onset and reduce the
effects of fatigue, implies an aerobic level of conditioning.
Force is the ability to overcome resistance: how well you
do in rough water, hills, or in the wind.
Speed Skills is the ability to move effectively while swimming,
biking, or running. A measure of economy and technique.
Muscular Endurance is the ability of the muscles to maintain
a relatively high force load for a prolonged time. A combination
of force and endurance.
Anaerobic Endurance is the ability to resist fatigue at
very high efforts when arm or leg turnover is rapid.
Power is the ability to apply maximum force quickly.
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Miscellaneous Factors
| Time to train: |
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| Iinjuries: |
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| Health: |
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| Body strength: |
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| Flexibility: |
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| Mental skills: |
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| Body composition: |
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| Nutrition: |
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Diet |
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What did you eat yesterday:
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| Comments questions:
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