Hypercat Racing Athlete Information Questionnaire

Contact Information

Name
Street
City State Zip

Phone:
Home                    Email
Work                     Fax
Mobile



If applicable, please check if you are a member of the following clubs:

Roaring Mouse Cycling Team
Golden Gate Triathlon Club
San Francisco Triathlon Club
TRIBE Triathlon Club
LA Triathlon Club
Rincon Triathlon Club
Other Club, please note:

Personal Information

Date of Birth        Age
Height Weight

Marital Status:
Single
Married                      Spouse's Name
Domestic Partner        Partner's Name

Children:
Do you have children?
Yes                    If yes, what are their name's & ages.
No

Occupation


Brief Job Description


How many hour's do you work in an average week?

Health & Medical Information

Are you currently under the care of a physician, chiropractor, or other health care professional for any reason?
Yes
No
If yes, please explain


Physician's Name        Physician's Phone
Physician's Address

Do you, or have you had, any of the following?

If yes, to any of the above please explain. 




Do you have a family history of any of the following conditions?

If yes, to any above please explain. 

    

Please list any medications taken on a regular basis (prescription/non-prescription). 
Note medication, dosage, frequency and reason.

 Are you allergic to any medications/foods/other? 


If yes, please explain.
What are you allergic to and your reaction?  


Are you on any specific food/nutritional plan at this time?   No Yes
If yes, please explain.

Do you take dietary supplements? If yes, please note what supplements you use. 
No Yes

Have you experienced a recent weight gain or weight loss?  
No Yes
If yes, please elaborate and over how long?

Which best describes your current stress level?
Low 
Low to Medium
Medium 
Medium-High   
High

Do you have any conditions that you believe may limit your physical activity?


Please list any current illness, recent injuries, 
recent surgeries, or past medical problems or surgery of note.

Please describe any past or current musculoskeletal conditions you have incurred. 
Please note any relevant: Surgery, back pain, muscle pulls, strains,
head, neck, upper back, shoulder, clavicle, arm, elbow, wrist, hand, 
lower back, hip/pelvis or lower leg/ankle/foot injuries.

Be sure to consult with your physician before starting this or any training regimen.

Athletic Background

How many years have you been swimming?
How many years have you been cycling?
How many years have you been running?

Please note if you competed in high school or college in any of the above sports.



List any significant athletic achievements/accomplishments including other sports
that you have participated or competed in.


Please outline your most recent race results and times.
Include date, event name, time, place in age group/overall and applicable splits.




Please list your personal best times in each of the following distances, as appropriate.

SWIMMING:

100                short course long course        Date
400                short course long course        Date
1500/1650      wetsuit no wetsuit                  Date
1.2 mile          wetsuit no wetsuit                 Date
2.4 mile          wetsuit no wetsuit                 Date

CYCLING:
Please note time and race name/location
10 mile           Date
40 km             Date
56 miles          Date
130 km           Date
112 miles        Date
Other              Date

RUNNING:
Please note time and race name/location
5k                        Date
10k                      Date
15k                      Date
10 mile                 Date
Half Marathon       Date
Marathon              Date
Other                   Date

Current Training Habits & Fitness Assessment

Please describe your current training. Include as much detail (including training mode, distance/duration, intensity)
as possible.


Rate your current fitness on a scale of 1 to 10. (1 = least fit, 10 most fit) 1 2 3 4 5 6 7 8 9 10

Do you train with a heart rate monitor? Yes No

If yes, which model (s) do you use?
If no, do you have an opinion on using a heart rate monitor. Please elaborate.


Do you know your current resting heart rate? Yes No
If yes, what is it?
When did you last measure your resting heart rate?

Do you know your max heart rate? Yes No
If yes, what is it?
When did you last test your max heart rate (running) and cycling

Do you keep a training log? Yes No
If yes, please create a typical entry below.



Do you have a training peaks account? Yes No
Have you ever used training peaks? Yes No

What does a typical, average training week look like?

Mode                                                    # weekly workout sessions            Weekly Hours            Weekly distance
Swimming                                             1 2 3 4 5 6 7 8 9 10                                                    
Cycling                                                 1 2 3 4 5 6 7 8 9 10                                                    
Running                                                1 2 3 4 5 6 7 8 9 10                                                    
Strength                                               1 2 3 4 5 6 7 8 9 10                                                    
Flexibility (yoga/pilates/stretching)          1 2 3 4 5 6 7 8 9 10                                                     
Body Work / Chiropractic                       1 2 3 4 5 6 7 8 9 10                                                     
Other training please describe

What is your current 100 interval pace in the pool?
What is your average running pace in minutes per mile?
What is your typical average speed for average training days on the bike?
Note the type of terrain that the majority of your riding is done on.

Over the past 4 weeks, what is the longest duration and distance you have competed in a single training session?

Swimming:     Time Distance
Cycling:         Time Distance
Running:        Time Distance

Looking ahead to your training preparations, how many hours can you train during peak volume?
5 or less 6-7 8-9 9-10 10-11 11-12 12-13 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23 23-24 24-25 25-30


Training Schedule / Habits -

Please note any schedule preferences or limitations below.

Do you swim with a masters team or club? Yes No
If yes, please note your masters group.
Please note the masters swim sessions available to you:


Do you ride with a cycling team or club? Yes No
Do you road race (crits, road races, stage races)? Yes No
If yes, please note your category (ie Cat 5, Cat 4, masters 3 etc)
Please note group ride days and times.

Do you train with a running team or club? Yes No
If yes, please note your running team/club.
Please note group run days and times.

Swim Training
Where do you do most of your swim training?
What size pool can you train in regularly?
25 yard
25 meter
33 yard (100 feet)
50 meter

Run Training
Where can you do your run training regularly. 
(Select all that apply)
Road
Trail
Track
Treadmill
Water Running
Underwater Treadmill

Bike Training
Where can you ride on a regular basis?
(Select all that apply)
Road Flat
Road Hilly (Short, steep)
Road Rolling Hills
Road Long Climbs
Off Road MTB / Cyclocross

What equipment do you have available?

Bike
(Select all that apply)
Rollers
Stationary Trainer (Fluid, Magnetic, Wind etc)
Computrainer
Spin Bike
Bike Computer with Cadence Function 
(Please note additional computer features of note, ie wattage etc)


What type (brand / model) of bike(s) do you own?

Describe or give examples of your favorite types of workouts. (swim/bike/run)

 
Describe or give examples of your least favorite workout types.

Personal Evaluation

Rate your confidence level on a scale of 1 to 10 (1 being low and 10 being highest) in each:

Swim Open Water 1 2 3 4 5 6 7 8 9 10
Swim Pool 1 2 3 4 5 6 7 8 9 10
Bike 1 2 3 4 5 6 7 8 9 10
Run 1 2 3 4 5 6 7 8 9 10

Rate your perception of your ability compared to your peers on a scale of 1 to 10.

Swim 1 2 3 4 5 6 7 8 9 10
Bike 1 2 3 4 5 6 7 8 9 10
Run 1 2 3 4 5 6 7 8 9 10


Please describe your best athletic attributes and strengths, both mental and physical.


Please describe your greatest athletic challenges/ areas in need of improvement, both mental and physical.
 

Coaching Expectations

Please describe what you are looking for in a coach and training program.  
Include your expectations of your Hypercat Coach.



Goals
What are your 3 major athletic goals for the next 12 months?   Be specific.



What races/events do you plan to compete in over the next 6 months to one year?
Please note any goals for each respective event, along with a priority ranking (A being highest and C being lowest).


Please make additional comments about your interests, priorities and anything else you would like us to know.




Thank you for investing your time in this athlete information questionnaire.
We will follow-up with you shortly.