Tri-Harder.co.uk
Lifestyle Questionaire
e-mail run4colin@aol.com
Tel:07725 691092 Lanzarote:+34 676234953 |
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| This form is for personal training, I can begin to write you a 4 week schedule if you follow the instructions below: |
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| Important: Use this form or a photocopy. Spend time to answer the questions fully, the more information the more accurate the schedule |
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| NAME
AGE
SEX M/F
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| ADDRESS |
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| POST CODE
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| TEL
MOBILE
E-MAIL
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| HEIGHT
WEIGHT
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| PAST PHYSICAL TRAINING |
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| SWIM
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| BIKE
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| RUN
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| WEIGHTS
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| OTHER
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| APLICABLE Personal Best’s:
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| CURRENT TRAINING – give brief details of what you currently do, make a note of sessions that you do not wish to change. |
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| FAVOURITE TYPES OF EXERCISE IN ORDER OF PREFERENCE |
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| 3.
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| 4.
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| 5.
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| 6.
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| FAVOURATE SESSION FOR YOUR CHOSEN SPORT |
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Goals:
Write out your goals in order of short, medium or long term. They must be realistic and achievable. They can be varied such as weight loss, cardiovascular improvement, more energy, reducing stress, diet change etc. Give yourself plenty of time to think about what you really want and what you think is possible.
An example of these could be:-
Short: = lose 4lbs fat (this probably is achievable)
Medium: = Improve 10K time from 42 minutes to 37 minutes in 4 months. (this may be too long term and I would recommend sub 40 as a medium goal and 37 as a long term goal)
Long: = Run your first marathon in 10 months. This would be a good long term goal. |
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Remember your goals change all the time! |
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YOUR GOALS: |
| SHORT
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| MEDIUM
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| LONG
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| GOAL DIARY: (give an approximate time plan to your goals, i.e. when you think you should reach them or your races when are they? And also a scale of importance - for instance (1 = training 5 = National championships) |
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| TIME AVAILABLE TO TRAIN
Take into account your current training and mention any set sessions that you do not want to stop, such as the Sunday club Bike Ride., or Tuesday night club swim, or Wednesday run with your friends. Also tell me what these sessions normally involve.
If you do no current training then that is OK, just indicate how much time you have available plus how much training you think you can do and when. |
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GOOD & BAD POINTS
Please make a comprehensive list of your good and bad points.
For example BAD points could be:- Overweight, inconsistent, family stress, illness, lack of knowledge, poor diet, slow swimmer, hate salads and fruit, etc.
GOOD points could be: - Enjoy running, like to train hard, motivated, plenty of time to train, family backing, training partners, etc.
(be honest and take your time to list everything you think may be valid. This will help me to create the best personalized schedule I can.) |
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 HEALTH SECTION
‘CONFIDENTIALITY’
This schedule questionnaire is strictly confidential. Please state if there is anything you can think of that may limit of affect your training in any way:
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1. When was the last time you were ill?
, What was it
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| 2. Are you recovering from a major illness?
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| 3. Are you on any medication and what is it for?
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| 4. Have your race times been getting worse lately?
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| 5 . Have you been exercising without any real problems and only had one or two colds a year?
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| 6. Have you been exercising for more than two years without problems and doing well in racing and training without injury?
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| 7. I last had a cold
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| 8. I last had flu |
| 9. How many hours sleep do you get per night on average?
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| 10. My resting pulse is
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(take first thing in the morning, a minute or so after you wake. Take it for five days then divide the total by five to give me your average resting heart rate.) |
| 11. My maximum heart rate is
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(Don’t Use 220 minus age formula, it is inaccurate) or Maximum heart rate test) |
| If you don’t know, this will be discussed before the tests are set |
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Do you own a heart rate monitor?
Yes
No |
| 13. I am a Cyclist
Yes
No |
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I am a runner
Yes
No |
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I am a Studio Cyclist
Yes
No |
| 16. I am a Triathlete
Yes
No |
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I am a?
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| 18. I want to be a
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| 19. My sizes are S
M
L
Waist
Chest
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Current ‘2008’ Costs (these prices are subject to change without prior notice)
First discussion / consultation + analysis of questionnaire – FREE
Initial Assessment work following discussions, setting training plan and client file (approx. 8 hours inc. work after initial meeting) Includes full fitness assessment, swim, bike, run analysis (if applicable) and session, other relevant training options to be used within any monthly schedule, full post report. - FREE
One to one training sessions - £15 per consultation
Monthly Options: (weekly or key session schedules available if necessary – cost TBA) |
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Bronze: 4 weekly training programme with weekly 1:1 progress discussions, each 2nd week 1:1 accompanied training sessions as per programme, e.g. outdoor run, gym session, swim session etc. Nutrition and dietary programme based on questionnaire goals, updated every 2nd week.
£40 per month
Silver: Full programme as bronze with the addition of weekly 1:1 accompanied training sessions, weekly update and modification of training programme, weight management programme including body fat/water content, BMI, Heart rate zone specific training and instruction.
£60 per month
Gold: Full programme as Silver with specific event focus, i.e. London Marathon, Walk of Life, first Triathlon, expert advice an event preparation, psychology, day by day preparation leading up to the event, Equipment advice and check including bike service by fully qualified mechanic, Tri-Harder coach accompany to event if required
£80 per month
All Programmes Include: all types of training: progressive training phases, training zones, contact hotline, logged training analysis, 4 weekly phases, seasonal periodization, and goal implementation.
All monthly options come with a 3 month MINIMUM commitment from both parties with payment made for the first month at the initial discussion, thereafter at the monthly one to one sessions, You may swap which programme option you require based on that month’s needs everything is flexible from month to month based on your own individual goals and needs. |
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Disclaimer
I know of no reason why I should not follow a physical training schedule or diet program written for me by Tri-Harder. I agree to a minimum of three months consultation with Tri-Harder. I will in no way hold the writers or coaches responsible for any loss, theft, damage, accident, illness or injury to me.
Full Name
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