Name
*
First Name
Last Name
Email Address
*
Age
Date Of Birth
Phone No.
Height (cm)
Weight current (kg)
Weight in racing (in-form)
Number of race / event days last year
Date of last race / event
Date you plan to return to training after break
Coming race / event program as you know it
Family situation: (if applicable)
Emergency Contact (Name & Number)
Parents Name/s and contact phone number
Special events that you have coming up: (weddings, exam dates, holidays)
Hobbies: (other than cycling:)
Are you in full / part time study / Work?
Current health status
Past Injuries/sicknesses
Current medical concerns
Allergies
Do you have any issues that you are "just dealing with"? (knee, hip, back, etc)
Doctor contact (only team doctors)
Were you happy with your season?
Yes
No
Kind Of
What worked? - (Training)
What didn't work?
What was your hardest part of the season?
What was the best part of the season?
What were the results / performances you were most proud of?
What do you think you can improve upon?
How are you with positioning in the peloton / group?
Good
Average
Bad
What is your greatest strength on the bike?
Do you tend to perform naturally better in some months during the season? If yes, when?
Do you have a current set threshold value?
Do you have a current set of HR Zones?
Do you have a current set of Power Zones?
Do you prefer to train with HR or power?
2 year goal(s): (Try to list 3)
5 year goal(s): (Try to list 3)
Have you worked with a trainer/coach in the past?
Yes
No
Who & When?
Did they provide you with weekly, bi-monthly, or monthly reports?
Can you provide your TrainingPeaks account? **Username:
What head unit do you use (Garmin / SRM etc)
How many Powermeters (cranks) do you have at home?
1
2
3
4
5
6
7
8
9
10
Have you worked with a sports phycologist (mental coach)? Who? When?
What did you work on?
What recovery techniques do you currently prefer?
Stretching
Yoga
Meditation
Other
Do you do a weight program (gym) in the off-season?
Yes
No
Do you work with a trainer (in the gym) or on your own?
With trainer
Alone
Do you currently have a "core" strength program?
Yes
No
Do you maintain your core strength during the season?
Yes
No
Is there anything that you need, but don't have at home to do your job better?
Would you consider yourself "sensitive" to slight differences in bike position?
Yes
No
Are you happy with your position or do you constantly change or "tinker"?
Happy
Constantly Change
Do you have / have you had any mental or emotional issues?
Do you feel confident in rides / races?
Yes
No
What are your fears (if any):
Do you have a positive attitude with yourself and others?
Yes
No
Unsure
Do you try to live in the present, or do you often think of the past or future?
Present
Past / Future
Do you try to take success out of every failure?
Yes
No
Do you have proper "life/work" balance?
Yes
No
On the fence
Do you tend to second guess your decisions?
Yes
No
Sometimes
For females, Do you have a regular menstrual cycle?
If yes, how long in duration is your cycle and do you notice any symptoms around training / racing?
If you don't have a regular cycle, when was your last period?
Anything else you want to add?
Where did you hear about my coaching?
If known, what coaching package are you interested in
