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Athlete Performance Coaching Questionnaire

Published

9 September 2024
1Personal Details
2Health & Exercise
3Medical
4Eat & drink & do
5Goals, challenges & areas for growth
6Additional information

Personal Details

Hidden
Hidden
Client Name(Required)
DD slash MM slash YYYY
Address(Required)

Smoking

Do you currently smoke?(Required)

Drink alcohol

How often do you drink alcohol?(Required)

Unhealthy habits (strictly confidential)

Are there any unhealthy habits that could be impacting your wellbeing or performance?  Tick below if you would like to discuss &/or understand more about the effects of continuing this habit.(Required)

Caffeine

Do you drink caffeinated beverages (i.e. coffee, tea, energy drinks)?(Required)

Sleep Patterns

How many hours of sleep do you get per night on average?(Required)
Do you wake up during the night?(Required)
Do you take sleeping tablets/natural substances for sleep?(Required)
Do you have a sleep routine?(Required)

Biological Markers

VO2 Max
Tested?
MM slash DD slash YYYY
A person’s VO2 max score measures the maximum amount of oxygen their body can use during intense exercise. It’s like a fitness gauge showing how well your heart, lungs, and muscles work together. Knowing your VO2 max helps track your fitness level, improve performance, and tailor workouts to get better results. It is the overarching factor of how much energy you are able to use.
HRV – Heart Rate Variability
Know HRV?
Heart rate variability (HRV) measures the time differences between heartbeats. A high HRV indicates good heart health and adaptability to stress. Improving your HRV boosts daily (& athletic) performance by helping your body recover faster and manage stress better, leading to better overall well-being and resilience.
Blood Tests
Can you provide any recent blood tests that cover your overall level of health (no older than 3-4 months)?(Required)
Please bring them along to the first consultation or email prior if the first session is virtual.
Body Scans
Can you provide a recent body scan that provides data on your fat %, lean muscle mass % etc (no older than 1-3 months)?(Required)
Please bring them along to the first consultation or email prior if the first session is virtual.

Medical History

Please tick any of the conditions or symptoms you have or had a history of:
Thyroid
For Male
For Female

Medication

Medical Questionnaire

Performance Coaching may involve demanding physical activity and can be strenuous and you need to be in good health to participate. The purpose of the Medical Questionnaire is to find out if you should be examined by a physician before participating in Performance Coaching Activities. A positive response means that there is a preexisting condition that may affect your health & safety when training and you may need to seek the advice of a physician (we will advise).

Please answer the following questions on your past and present medical history by ticking YES or NO. If you are not sure, answer YES. Please provide further information on your answer in the spaces provided below each question.
Do you have a history of seizure disorder, stroke, brain surgery, black out, severe migraine headaches, vertigo or dizzy episodes, significant head injury or aneurysm of the brain’s blood vessels?(Required)
Do you have a history of heart attack, heart surgery, irregular heart beat, angina/heat pain, heart disease, uncontrolled elevated blood pressure (hypertension), heart murmur, known patent foramen ovale (PFO), high cholesterol, anaemia or unusual shortness of breath or chest pain during exertion?(Required)
Do you have a history of spontaneous collapsed lung, collapsed lung due to injury, cysts or air pockets of the lungs, severe damage to lung tissue, emphysema, pneumonia or any lung problem which interferes with your ability to breathe?(Required)
Do you have a history of tumour, polyps, or cyst of the sinus cavities or nasal passages, major sinus surgery, or persistent sinus infection?(Required)
Have you had a history of asthma or asthma attacks in the last 12 months requiring medical attention? Any condition requiring medication and/or use of an inhaler for control of wheezing?(Required)
If you have diabetes, Type1 or Type 2, have you had any trouble controlling your blood glucose in the last 3 months?(Required)
Do you have any diagnosed muscle, joint or bone pain or problems that coud be made worse by doing physical exercise?(Required)
Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?(Required)

What I eat & drink & do

In the section below, please record below what you eat & drink (including supplements) in a normal day (& the time). Please be as descriptive as possible i.e. instead of just writing ‘chicken and vegetables’ you would include the types of vegetables, instead of ‘pasta & sauce’ you would include type of pasta & what sauces, dressings etc. The more information you provide, the better Robbo can assist you.

Please then ALSO record what fitness activities you do in a normal day (& the time). Be informative i.e. instead of just writing ‘jogging’, you would include how far/long and the intensity etc.

To continue you must add at least 3 entries.
Choose a day that replicates the way you eat & train ‘most’ days. Thank You.
Nutrition, Hydration, Supplementation
Time of Day
Physical Activity
Time of Day

Your goals, challenges & areas for personal growth

Please take a moment to tell Robbo what challenges and/or goals you would like assistance with. Thank You!

A Snapshot

If you’re unsure of any answers below, please write “to be discussed”.

Clarity

If you’re unsure of any answers below, please write “to be discussed”.

Energy

If you’re unsure of any answers below, please write “to be discussed”.

Well-being Self Assessment | SCALE 1 = LOW through to 10 = HIGH

In the spaces below, please fill in your scores 1-10 for each. Briefly explain your score, thank you.
  • 0
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  • 10
Please enter a number from 0 to 10.
  • 0
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  • 10
Please enter a number from 0 to 10.
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  • 10
Please enter a number from 0 to 10.

Additional information you wish to share

The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition.
DD slash MM slash YYYY
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