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Performance Questionnaire

    Your Details

    Contact Info

    Your Address

    Medical History

    Is this your normal weight? YesNo

    General condition

    Please indicate if you have EVER had any of the following
    Diabetes YesNo
    Pneumonia YesNo
    Back/Joint Pain YesNo
    Heart Murmur YesNo
    Heart Disease YesNo
    Angina/Chest Pain YesNo
    Hepatitis YesNo
    High Blood Pressure YesNo
    Kidney infection YesNo
    Infectious Mono YesNo
    Head Injury YesNo
    Other? Please give further info

    Cardiovascular

    Are you suffering from a heart condition (heart attack, angina, irregular heart beat, hole in your heart)? YesNo
    Do you feel pain in your chest when performing physical activity? YesNo
    Do you suffer from high or low blood pressure? YesNo
    Are you currently taking medication to control your blood pressure or a heart condition? YesNo
    Do you have a back or joint problem that could be made worse through physical activity? YesNo
    Do you knowingly suffer fro diabetes? YesNo
    Do you suffer from respiratory illness (asthma, bronchitis, emphysema) or have shortness of breath with mild exertion? YesNo
    Are you under medical treatment for any illness? YesNo
    Are you pregnant, or given birth in the last 3 months? YesNo

    Medical

    Please fill in any information you think is relevant

    Lifestyle

    Please give details of anything you think may affect schedules and training

    Exercise Schedule

    Please inditcate your avilability

    Mon Tue Wed Thu Fri Sat Sun
    Hours each day

    Your Psychological state

    Give yourself a value score in the following areas. Be honest with yourself, there are no right or wrong answers.
    Self awareness PoorFairGoodVery GoodExcellent
    Level of confidence to complete your main priority event PoorFairGoodVery GoodExcellent
    Ability to set goals and targets PoorFairGoodVery GoodExcellent
    Ability to follow through on set goals PoorFairGoodVery GoodExcellent
    Use of visualisation/imagery to prepare for a race PoorFairGoodVery GoodExcellent
    Use of self talk/thought control PoorFairGoodVery GoodExcellent
    Ability to pay attention/focus under stress PoorFairGoodVery GoodExcellent
    Ability to endure peak sensation PoorFairGoodVery GoodExcellent
    Ability to excel under pressure PoorFairGoodVery GoodExcellent
    Ability to make decisions under stress PoorFairGoodVery GoodExcellent
    Consistency PoorFairGoodVery GoodExcellent
    Ability to take recovery days without guilt PoorFairGoodVery GoodExcellent

    Athletic History

    Please list any past Endurance Events completed: Runs, Sportives, Swims, OCRs or other
    Event Type When Time Rank/Position Notes/Comment

    Running

    Please fill in where this activity is relevant to your training.
    Total weekly distance
    Weekly Frequency
    Longest swim
    Do you plan your swim workouts?
    Rate your Swimming ability (1-5)
    What do you think are your limiters?
    What do you think are your strengths?
    What equipment do you own?

    Swimming

    Please fill in where this activity is relevant to your training.
    Total weekly distance
    Weekly Frequency
    Longest swim
    Do you plan your swim workouts?
    Rate your Swimming ability (1-5)
    What do you think are your limiters?
    What do you think are your strengths?
    What equipment do you own?

    Biking

    Please fill in where this activity is relevant to your training.
    Total weekly distance
    Weekly Frequency
    Longest swim
    Do you plan your swim workouts?
    Rate your Swimming ability (1-5)
    What do you think are your limiters?
    What do you think are your strengths?
    What equipment do you own?

    OCR (Obstacle Course Racing)

    Please fill in where this activity is relevant to your training.
    Rate your Swimming ability (1-5)
    What do you think are your limiters?
    What do you think are your strengths?
    What equipment do you own?

    Equipment

    Which of the following equipment do you have access to (Please specify at home or via a gym)?
    Resistance Machines HomeGymHome & GymNo
    Cable Machines HomeGymHome & GymNo
    Barbells HomeGymHome & GymNo
    Medicine Balls HomeGymHome & GymNo
    Suspension Trainers HomeGymHome & GymNo
    Battleropes: HomeGymHome & GymNo
    Kettlebell HomeGymHome & GymNo
    Other (please specify)

    Upcoming races

    Events Planned for this Season (in order of priority) *If not sure, list any races you are considering so can discuss what will be your best options.
    Race Name Race Date Race Type Race Distance

    Strength and Conditioning (S&C)

    Describe your current S&C program (include organised classes, frequency and duration of sessions etc):

    Other info

    Please use this space to give any other information you think will be useful, that isn’t included in this form.