Forza Performance Athlete Questionnaire

Your Details

Your Name (required)

Your DOB (required)

Contact Info

Your Email (required)

Your Phone/Mob

Your Address

House/Flat Number/Name (required)

Street (required)

Town/City

County

Postcode (required)

Medical History

Your DOB (required)

Gender

Height

Weight

Is this your normal weight?
YesNo
Resting HR (if known)

Blood {Pressure} (if known)

General condition

Please indicate if you have EVER had any of the following

Cardiovascular

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.

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)?

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.

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

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

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)

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

Menu

Forza Performance Athlete Questionnaire

Your Details

Contact Info

Your Address

Medical History

General condition

Cardiovascular

Medical

Lifestyle

Exercise Schedule

Your Psychological state

Athletic History

Running

Swimming

Biking

OCR (Obstacle Course Racing)

Equipment

Upcoming races

Strength and Conditioning (S&C)

Other info