Nicole Tackett
coach@nicoletackett.com
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Coaching Intake-Form
Coaching Intake-Form
Coaching In-Take Form
A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator.
1. Contact information
First Name
Last Name
Email
Phone
Address
2. Briefly describe yourself as you feel comfortable. Work, family, community, etc.
3. Health History
a. Current injuries
No
Yes
Please Describe
b. Past Injuries
No
Yes
Please Describe
c. Do you have any family history that should be identified(heart disease, high blood pressure, diabetes, etc.)
d. Do you have any current medical concerns that should be identified?
4. Goals
a. What are your short term goals for coaching?
b. What are your long term goals?
c. Do you have any races planned?
No
Yes
If yes, names and dates?
Do you: (check all that apply)
Have weight training experience?
No
Yes
If yes, please explain
Belong to a gym?
No
Yes
If yes, please explain
Have access or participate in a Masters Swim Program?
No
Yes
If yes, please explain
Access or participate in a Spin or Indoor Cycling Program?
No
Yes
If yes, please explain
Work with a personal trainer or attend group strength classes?
No
Yes
If yes, please explain
What is your preferred rest day?
What is your preferred week look like?
Do you have experience with a heart rate monitor?
Do you have a fitness watch? (Apple, Garmin, etc.)? Please list make and model.
Are there certain types of training you enjoy?
Are there certain types of training you dislike?
Is there anything else that would be important for your coach to know when designing your program and training plan? The more information that you can provide will assist your coach in assessing and making recommendations and improvements to your training.
The information that I have given is true and correct to the best of my knowledge. Should any conditions change, I agree to notify my coach immediately.
I agree
I do not agree
Submit
