Email *
Phone
Are you an Elite Athlete? * Yes No
If so, what sport (s) and position (s) do you play?
If not, have you previously competed in sports, please elaborate
On average, how many times per week do you exercise? * * Zero 🙁 1-2 Times Per Week 3-4 Times Per Week 5+ Times Per Week
What type of exercises/routine do you perform now? Ex. cardio 2x per week, strength training {targeted muscle groups, total body}, etc. * *
Tell us about a time when you were most "fit" in your lifetime. Include activities you were performing. *
Are you right or left handed? * Right Left
Describe any injuries/discomfort you may have *
Have you undergone any surgeries or traumatic events? Please be as descriptive as possible, this may include car accidents, concussions, broken bones, falls, dental work, etc. *
Please describe any scars or tattoos you may have and what areas
Do you wear glasses or contacts? When and for how long? Knowlingly, near or far-sighted? *
Do you have weak balance? Or do you experience vertigo, migraines, frequent headaches/stomach aches, dizzy spells, car sickness, IBS/gut irritability, long-term use of antibiotics, etc.? *
Are you currently taking any medication or have any medical conditions? *
Elite Goals in Mind (lose weight, enhance sports performance (improve shot, speed..), gain weight etc) *
Convenient time(s) to train (AM, Afternoon, PM)? *
Have you worked with a Trainer/Strength and Conditioning Coach before? * Yes No
If so, describe your experience (likes, dislikes)
On a scale from 1-10, 10 being the highest, how serious are you about enhancing your performance? * 1 2 2 4 5 6 7 8 9 10
