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Forza Performance Athlete Questionnaire

    Your Details


    Contact Info


    Your Address





    Medical History




    Is this your normal weight?
    YesNo

    General condition


    Please indicate if you have EVER had any of the following

    Diabetes

    YesNo

    Pneumonia

    YesNo

    Back/Joint Pain

    YesNo

    Heart Murmur

    YesNo

    Heart Disease

    YesNo

    Angina/Chest Pain

    YesNo

    Hepatitis

    YesNo

    High Blood Pressure

    YesNo

    Kidney infection

    YesNo

    Infectious Mono

    YesNo

    Head Injury

    YesNo

    Other? Please give further info

    Cardiovascular

    Are you suffering from a heart condition (heart attack, angina, irregular heart beat, hole in your heart)?

    YesNo

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

    YesNo

    Do you suffer from high or low blood pressure?

    YesNo

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

    YesNo

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

    YesNo

    Do you knowingly suffer fro diabetes?

    YesNo

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

    YesNo

    Are you under medical treatment for any illness?

    YesNo

    Are you pregnant, or given birth in the last 3 months?

    YesNo

    Medical

    Please fill in any information you think is relevant







    Lifestyle

    Please give details of anything you think may affect schedules and training








    Exercise Schedule

    Please inditcate your avilability




    Mon

    Tue

    Wed

    Thu

    Fri

    Sat

    Sun

    Time Available

    Swim

    Bike

    Run

    Strength

    Your Psychological state


    Give yourself a value score in the following areas. Be honest with yourself, there are no right or wrong answers.

    Self awareness

    PoorFairGoodVery GoodExcellent

    Level of confidence to complete your main priority event

    PoorFairGoodVery GoodExcellent

    Ability to set goals and targets

    PoorFairGoodVery GoodExcellent

    Ability to follow through on set goals

    PoorFairGoodVery GoodExcellent

    Use of visualisation/imagery to prepare for a race

    PoorFairGoodVery GoodExcellent

    Use of self talk/thought control

    PoorFairGoodVery GoodExcellent

    Ability to pay attention/focus under stress

    PoorFairGoodVery GoodExcellent

    Ability to endure peak sensation

    PoorFairGoodVery GoodExcellent

    Ability to excel under pressure

    PoorFairGoodVery GoodExcellent

    Ability to make decisions under stress

    PoorFairGoodVery GoodExcellent

    Consistency

    PoorFairGoodVery GoodExcellent

    Ability to take recovery days without guilt

    PoorFairGoodVery GoodExcellent










    Athletic History


    Please list any past Endurance Events completed: Runs, Sportive's, Swims, OCR’s or other

    Event Type

    When

    Time

    Rank/Position

    Notes/Comment

    Running


    Please fill in where this activity is relevant to your training.

    Total weekly distance

    Weekly Frequency

    Longest swim

    Do you plan your swim workouts?

    Rate your Swimming ability (1-5)

    What do you think are your limiters?

    What do you think are your strengths?

    What equipment do you own?

    Swimming


    Please fill in where this activity is relevant to your training.

    Total weekly distance

    Weekly Frequency

    Longest swim

    Do you plan your swim workouts?

    Rate your Swimming ability (1-5)

    What do you think are your limiters?

    What do you think are your strengths?

    What equipment do you own?

    Biking


    Please fill in where this activity is relevant to your training.

    Total weekly distance

    Weekly Frequency

    Longest swim

    Do you plan your swim workouts?

    Rate your Swimming ability (1-5)

    What do you think are your limiters?

    What do you think are your strengths?

    What equipment do you own?

    OCR (Obstacle Course Racing)


    Please fill in where this activity is relevant to your training.

    Total weekly distance

    Weekly Frequency

    Longest swim

    Do you plan your swim workouts?

    Rate your Swimming ability (1-5)

    What do you think are your limiters?

    What do you think are your strengths?

    What equipment do you own?

    Equipment


    Which of the following equipment do you have access to (Please specify at home or via a gym)?

    Resistance Machines

    HomeGymHome & GymNo

    Cable Machines

    HomeGymHome & GymNo

    Barbells

    HomeGymHome & GymNo

    Medicine Balls

    HomeGymHome & GymNo

    Suspension Trainers

    HomeGymHome & GymNo

    Battleropes:

    HomeGymHome & GymNo

    Kettlebell

    HomeGymHome & GymNo

    Other (please specify)

    Upcoming races


    Events Planned for this Season (in order of priority)
    *If not sure, list any races you are considering so can discuss what will be your best options.

    Race Name

    Race Date

    Race Type

    Race Distance

    Strength and Conditioning (S&C)


    Describe your current S&C program (include organised classes, frequency and duration of sessions etc):

    Other info


    Please use this space to give any other information you think will be useful, that isn’t included in this form.