Athletic Questionnaire

Personal Information
First Name   Last Name
 
Address   City   State   Zip
     
Home Phone   Work Phone   Email
   
Whom referred you to the Wilson Coaching Group?  
Height   Weight   Birthdate
 feet    inches
 
 pounds  
 
 /   / 
Occupation  
Any Health Related Problems?

Goals & Athletic Background
This Seasons 'A' Race
Other Races Scheduled For This Season So Far  
 
Swimming
Number of times you currently swim per week
  
Do you have access to open water for swimming?
   Yes
No
Do you belong to a Master's swim program?   Yes
No
Average pace for 100 m or yd  
Cycling
Current average weekly mileage  
Do you own an indoor training device?
   Yes
No
If so What type?  
Do you own a wattage measurement device I.e Powertap etc.   Yes
No
Does your bike computer have a cadence feature   Yes
No
Do you belong to a cycling club?  
Running
Do you belong to a running club?  
Average weekly mileage  
Average longest run each week  
How often do you run?  
Best 10km time  
Other Information
Do you own a heart rate monitor?   Yes
No
Does your HRM Interface with your PC?   Yes
No
Have you had a blood drawn LT test in the last 6 months   Yes
No
Cycling results  
Running results:  
Best ever Olympic race
Name   Location   Year   Time
     
Best ever half IM race
Name   Location   Year   Time
     
Best ever IronMan race
Name   Location   Year   Time
     
 

What is your typical available time to train per day:
Monday   Tuesday   Wednesday
   
Thursday   Friday   Saturday
   
Sunday        
       
Please add any thoughts you may have that would help the coaches