Telephone: (H) ____________________ (W)________________________ Fax: _____________________

Profession: __________________________________ email: ___________________________________

PERSONAL PHYSIOLOGY: ( if known and optional - but helpful for program planning )

Height: ___________________Weight: _________________________ Bodyfat: _____________________

Maximum Heart Rate: sports -______________________________________________________________

VO2 Max: sports -_______________________________________________________________________

Anaerobic Threshold:__________________________ Average Resting Heart Rate:___________________

SPORT RELATED:

Sports: _____________________________________________ Competition Level: __________________

Years Competing:_____________ Favorite Events, Distance and Best Times:________________________

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AVERAGE TRAINING TIME AVAILABLE EACH WEEK: ( hours )

Mon_________Tues_________Wed_________Thurs_________Fri_________Sat_________Sun_________

Medical History: (include allergies, operations, joint/muscle pain etc.)____________________________

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Family Doctor: ______________________________________________ Phone: ____________________

Strengths/Weaknesses: ( personality/training abilities ) __________________________________________

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Goals/Ideals: ( State goals and ideals. List event dates and distances.) ____________________________

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Training History: ( Please describe a typical week of training from the past month.)___________________

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