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The Sport Factory

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Start Up Kit

Step 1 Please tell us about yourself. Once you submit your start up questionnaire your coach will contact you to set up a consultation and discuss your answers in detail. All questions indicated with an * are required for completion.

 



General / medical information
* 1. Name
 
* 2. Address
 
* 3. City, State, Zip
 
* 4. Email
 
* 5. Contact phone
 
  6. Other phone (cell,work, or home)
 
  7. Emergency Contact: Name and phone
 
* 8. Age
 
* 9. Height
 
* 10. Weight
 
  11. DOB
 
  12. Body fat (percent)
 
  13. Resting heart rate
 
  14. Blood pressure
 
Please list any muscular skeletal injuries you have experienced. Include type of injury, date, and treatment. Be specific.
  15. Sports Injuries
 
Please check if you have any of the following medical conditions
  16. Medical Conditions
 
 
 
 
 
 
 
 
 
 
 
  17. Surgery in the last year? Please be specific
 
  18. Do you ever experience back or neck pain? If so, please explain.
 
  19. Do you have any condition that will limit high intensity exercise?
 
 
 
  20. Medications or supplements you are taking.
 
  21. Last Physical Exam (date)
 

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