ONLINE TRAINING APPLICATION

Force X Velocity I Athlete Testing

ONLINE TRAINING APPLICATION

ONLINE TRAINNG FORM

Name *

First

Last

Male or Female *

Male Female

Email *

Date of Birth *

Sport or Occupation *

Training Goals

Training goal 1 & time frame to achieve *

Training goal 3 & time frame to achieve *

Training goal 2 & time frame to achieve *

Training Info

How many session per week can you realistically stick to? *

1 2 3 4 5 6

How long do you have to spend for each training session? *

30min 45min 60min 90min

What other training sessions do you have on during the week? and on what days? *

What is your training history and experience. Ie how long have you been training for and what level would you class yourself? Novice, Intermediate, Advanced *

Are there any exercises or styles of training that you don't like? *

What facilities and equipment do you have access to? *

Injuries

Have you had any injuries? If so what was the injury and on which part of the body? *

Medical

Medical Provider(s) Name and Contact *

Are you on any medication? If so please list *

Pregnant (Now or in the last 12 months *

Yes No

Epilepsy *

Yes No

Arthritis *

Yes No

Asthma *

Yes No

Do you have any current injuries or previous injuries that affect your training? *

Father or brother under the age of 55 years with a history of heart disease or stroke? *

Yes No

Mother or sister under the age of 65 years with a history of heart disease or stroke? *

Yes No

Diagnosed type 1 or type 2 diabetes *

Yes No

Blood Pressure *

Yes No

Over 140mm/hg Systolic or 90mm/hg Diastolic or on blood pressure medication?

Smoking? Currently or within the last 6 months *

Yes No

ACE Inhibitors *

Beta Blockers ACE Inhibitors Diuretic Statin Oral Hypoglycemic Other

Cardiovascular or Pulmonary Condition? *

Yes No

Diagnosed heart condition or stroke or unreasonable leg or chest pain? Blood Pressure over 200/100mm/hg? Diagnosed Pulmonary Disease

If you ticked yes to this question proceed only under medical guidance

Any other comments *

Submit

CONTACT US

PHONE:
0273398398

EMAIL:

steve.buckley@fxvnz.com

Name *

First

Last

Email *

Comment *

Submit

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Home
About
Contact
Online Programming
Training
Mental Performance
Nutrition
Massage