New Athlete Form

New Athlete Questionnaire

Please take some time to fill out this questionnaire completely. The more information you can provide, the better your training program design will be.

Racing Season & Goals

Event Name	Date	Priority (A-C)	Goals

Personal Records

Distance	Swim Split	Bike Split	Run Split	Overall	When?	Where?
Olympic
Half-iron
Ironman
500yd/m Swim
1000yd/m Swim
1650yd (1mi) Swim
40km TT Bike
Century Bike (100mi)
5km Run
10km Run
13.1mi Run
26.2mi Run

Equipment & Logistics Table

EQUIPMENT & LOGISTICS
Item	Options	Details
Wetsuit?	Yes No
Fins?	Yes No
Kickboard?	Yes No
Hand paddles?	Yes No
Pull buoy?	Yes No
Masters Team?	Yes No
Bike #1	Road Tri
Bike #2	Road Tri
Front Chain Rings
Rear Cassette	Yes No
Power Meter?	Yes No
Heart Rate?	Yes No
GPS?	Yes No
Cadence/metre?	Yes No
Treadmill access?	Yes No
Track access?	Yes No
Trail access?	Yes No
Running club/team?	Yes No
TrainingPeaks account?	Yes No
WKO+ software?	Yes No
Tri club/team?	Yes No
Medicine ball?	Yes No
Swiss ball?	Yes No
Yoga class, Pilates?	Yes No
Free weights, gym machines?	Yes No
XC skiing or snowshoe?	Yes No
Other?	Yes No
Other?	Yes No

A Typical Week Schedule

Time	Please indicate your sport scheduling preferences, key workouts & off days, and the time you have available for training.
MORNING
LUNCH
EVENING
TOTAL HRS
RESPONSIBILITIES

Coaching & Mental Skills

COACHING & MENTAL SKILLS
Please rank yourself for these mental skills relative to athletes in your age-division. (1=Poor, 5=Average, 10=Excellent) For any score lower than 5, please describe or give an example.
Confidence
Pain tolerance
Setting daily goals
Visualization skills
Focus during practice
Focus during racing
Self-talk
Dealing with setbacks
Mental toughness
Sense of humor
Relaxation
Coachability
Please give a short summary of your athletic background, including high-school, college, and any professional sports.
What are your strengths as a triathlete, cyclist, or runner?
What skill(s) would you most like to improve this season?

Coaching Questionnaire

Current weight:		Weight 5 years ago:
Last Physical Check-up:		Resting HR:
Height:		Blood Pressure:

Breno Melo Endurance Coaching LLC

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New Athlete Questionnaire

Contact Info

Heart problems or chest pains?	Yes No

Diabetes mellitus?	Yes No

Gastrointestinal problems?	Yes No

Seizures/migraines of any kind?	Yes No

Asthma?	Yes No

Anxiety/panic attacks?	Yes No

Fractures of any bones?	Yes No

Ruptures of muscles/ligaments?	Yes No

Surgery that might affect sport performance?	Yes No

Blackouts, dizziness, or memory loss?	Yes No

Overuse injuries, such as IT Band Syndrome?	Yes No