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B78 Athlete Questionnaire Cycling
If you are experience any difficulties or have questions when filling out this form please don't hesitate to contact us at
info@b78coaching.com
**Before proceeding with any physical activities or training with B78/Jasper Blake Incorporated please consult your physician**
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Name:
Your answer
Address:
Your answer
Phone Number:
Your answer
Email:
Your answer
Date of Birth:
Your answer
Height:
Your answer
Weight:
Your answer
Emergency Contact
Your answer
Clothing Size
Biking Jersey
X Small
Small
Medium
Large
XLarge
Clear selection
Biking Shorts
X Small
Small
Medium
Large
XLarge
Clear selection
Shoe Size
Your answer
Goals
Short Term Goals (This year)
Your answer
Intermediate Goals (Next 2 years)
Your answer
Long Term Goals (Next 4 years)
Your answer
Racing
A Races- Most Important
Your answer
B Races- Important but can train through (up to 4)
Your answer
C Races- Least Important, used for training (unlimited)
Your answer
General
How many years have you been cycling?
Your answer
Do you have a background in cycling?
Your answer
Are you training on your bike for the purpose of cycling triathlon?
Your answer
Which discipline of cycling are you training for?
Road
Mtn. Bike
Track
Cyclocross
Clear selection
What event(s) and specific distance are you training for?
Gran Fondo
Centurion
Multi Day Bike Event
Other
Clear selection
If 'Gran Fondo' or 'Other' please specify:
Your answer
Of the three disciplines, which do you consider your weakest?
Climbing
Flats
Sprinting
Clear selection
Of the three disciplines, which do you consider is your strongest?
Climbing
Flats
Sprinting
Clear selection
Of the three disciplines, which do you like the least?
Climbing
Flats
Sprinting
Clear selection
Of the three disciplines, which do you like the most?
Climbing
Flats
Sprinting
Clear selection
How many years have you been doing some kind of structured sport?
Your answer
Do you have a background in any sport and if so, which one(s)?
Your answer
How many days per week do you currently ride?
Your answer
How many hours per week do you currently ride?
Your answer
What is the longest bike ride you have ever done?
Your answer
What is the longest bike ride you have done in the last 6 weeks?
Your answer
Do you ever ride with a group?
yes
no
Clear selection
If yes, how big/small is that group?
Your answer
What is the group ride like? Flat or hilly? What is the distance and time? Are you one of the weakest or strongest? What is the average speed on the rides?
Your answer
Are you comfortable riding in groups?
yes
no
Clear selection
If you have access to and enjoy riding with a group, what days do they train?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Clear selection
Do you have one or two good training partners of similar strength to train with?
Your answer
Have you had a comprehensive bike fit done (please specify who with)?
Your answer
What aspect of cycling do you feel you need to improve the most in order to reach your goals?
For example: Climbing, Sprinting, Time Trialing, riding in a group, drafting, bike handling skills.
Your answer
What is the average number of hours you currently train during the week (include all other activities)?
Your answer
What is the maximum number of hours you can or have trained during a week (include all other activities)?
Your answer
What are your best days for longer sessions (3+ hours)?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Clear selection
What are your best days for easy or off days (days you spend with friends/family)?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Clear selection
Do you use your bike for daily activities like commuting to work or running errands?
Your answer
Do you typically leave on your bike from your home to do training rides or do you have to drive to a starting point?
Your answer
How long does it take until you get to good roads and you're out of the city?
Your answer
Can you do any cross training for cycling?
Your answer
Do you do any of the following during any times of the year?
Run
Hike
Play other sports
Cyclocross
Mtn. Bike
Clear selection
Do you regularly stretch
Yes
No
Clear selection
Do you regularly do any core exercises?
Yes
No
Clear selection
Health Status
Are you currently injured in any way, shape or form?
Your answer
Do you have nay chronic problems or health concerns?
Your answer
Have you ever had a stress fracture or an impact stress injury?
Your answer
Do you have any medical issues that may interfere with your training/racing?
Your answer
Are you allergic to anything?
Your answer
Days of the Week
Brief description of your commitments on each day, independent of training.
Monday
Your answer
Tuesday
Your answer
Wednesday
Your answer
Thursday
Your answer
Friday
Your answer
Saturday
Your answer
Sunday
Your answer
Strength Training (Weight Room)
Do you have experience weight lifting?
Your answer
Are you currently working with a strength-training specialist?
Your answer
Do you have access to a good weight room?
Your answer
If you have weight trained in the past do you find that you are predisposed to putting on muscular mass quickly?
Your answer
If you do not have strength training program, would you be interested in purchasing a cycling specific functional strength program to match the needs of your cycling program?
Your answer
Your answer
Best Times
If available.
10km
Your answer
40km
Your answer
90km
Your answer
180km (Ironman)
Your answer
Other Distances
Your answer
Other Sports- Please specify sport, distance and time.
Your answer
Race Results
Please list your top 5 race results (if available).
Your answer
Recovery
Do you see a massage therapist on a regular basis?
Your answer
Do you see a physiotherapist or chiropractor on a regular basis?
Your answer
What forms of recovery, if any, are you currently implementing into your training/routine?
Your answer
Nutrition
Are you a vegeterian?
Yes
No
Clear selection
Do you have any food allergies or foods that you avoid for any reason?
Your answer
Do you drink coffee?
Please specify frequency.
Your answer
Briefly describe your general eating habits. Would you consider yourself a healthy eater, a moderately balanced eater (bit of everything), or a poor eater (crave and eat "junkfood" frequently)?
Be honest.
Your answer
Equipment
Please identify the bikes you have access to for training.
Road Bike, Winter/Training Road Bike, Time Trial Bike, Cyclocross Bike, Mountain Bike, Fixed Gear Bike.
Your answer
What shoes do you use to ride with?
Road Biking Shoes, Triathlon Shoes, Mountain Bike Shoes, Normal Running Shoes.
Your answer
Do you have a Power Meter?
If so, what kind?
Your answer
Do you have a Heart Rate Monitor?
If so, what kind?
Your answer
Do you have a GPS system?
If so, what kind?
Your answer
Do you have the following for running?
Training Shoes fit and recommended for your feet
Racing Flats
Heart Rate Monitor
GPS system
If you have a Heart Rate Monitor and/or GPS system for running, what kind is it?
Your answer
Technology/Internet
Do you have experience with any online log and training programs?
Training peaks.
Your answer
Are you willing to keep an online logbook of your day-to-day activities?
Your answer
Fitness Measures
Have you ever had a lactate threshold test, VO2 max test, Aerobic Capacity test, step test or any kind of aerobic fitness testing?
Your answer
Do you know the following values: Bike Threshold, Wattage and Heart Rate?
Your answer
Do you have threshold numbers for any other type of aerobic sport?
Your answer
If you'd like us to follow you on Social Media, please provide your social channels so we can follow you!
Your answer
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