Athlete Pre-Training Questionnaire

Please take a few minutes to fill out our coaching interest form. A Hypercat coach will follow up with you shortly after receiving your information to arrange for a consultation in person or via phone/Skype.

* Required fields

Name *

E-mail Address *

Street Address *

City *

State *

Zip *

Home Phone *

Cell Phone

Date of Birth *

Height *

Weight (lbs) *

Marital Status

Occupation *

Average Work Week Hours *

Job Stress Level *

Are you under the care of a physician? *

Physician's Name

Physician's Phone

Do you/have had: Heart Disease? *
Yes
No

Heart Attack? *
Yes
No

Heart Surgery *
Yes
No

Heart Murmur *
Yes
No

Hypertension *
Yes
No

Thyroid Problems *
Yes
No

Asthma *
Yes
No

Wheezing *
Yes
No

Diabetes *
Yes
No

Individual Anemia *
Yes
No

Stress Fracture *
Yes
No

Family History of Heart Disease *
Yes
No

Family History of Heart Attacks *
Yes
No

Family History of Hypertension *
Yes
No

If yes to any of the previous medical conditions, please explain.

Are you currently taking any Medications? If so, please note below.

Do you have an allergies / known allergic reactions? If yes, please note below.

Are you on a specific Nutritional Plan?

Dietary Supplements?

Experienced a recent weight gain or loss?

Please comment/explain below any yes answers to above.

Describe any conditions that limit your physical activity.

Describe your Athletic History - High School. College. Post College. *

Briefly describe your current training. *

What are your 3 major goals for the upcoming year? *

What race(s) do you have planned / would you like to do in the coming year?

Which Coaching Package are you interested in? *

Would you like to receive our monthly newsletter with training tips, gear reviews and discounts? *
Yes
No

I have read and agree to the Privacy Policy *

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