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ATHLETE QUESTIONNAIRE
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Completing our Athlete Questionnaire helps us customize the best training, nutrition, and testing program for your physical development and athletic performance goals, sport and position specific needs.
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CoachGreenUSA.com
Athlete’s Name
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Your answer
Athlete’s Mobile Phone
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Your answer
Instagram
Your answer
Twitter
Your answer
Address, City, State, and Zip Code
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Your answer
Birthdate and Age
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Your answer
Height and Weight
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Your answer
Body Type
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Skinny
Slim
Average
Athletic
Muscular
Overweight
Obese
Other:
Required
Projected Height as an Adult
Under 5’5”
5’6”” to 5’8”
5’9” to 5’11”
6’0” to 6’2”
6’3” to 6’5”
6’6”” to 6’8”
6’9” or taller
Other:
Medical History including any serious Injuries and Surgeries
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Your answer
List Food Allergies and/or any Medication
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Your answer
School Name
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Your answer
Primary School Sport and Position
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Your answer
Secondary School Sport and Position
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Your answer
School Grade
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6th
7th
8th
9th
10th
11th
12th
Freshmen in College
Sophomore in College
Junior in College
Senior in College
College Graduate
Other:
Required
School Team Level of Play
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7th Grade
8th Grade
Freshmen
Sophomore
JV
Varsity
JUCO
College JV
College Varsity
In College - Playing Pro
Other:
Required
Select Team Name
Your answer
Select Team Sport and Position
Your answer
Select Team Level of Play
12U
13U
14U
15U
16U
17U
18U
Other:
Individual Awards and Rankings for Primary School Sport
All District Honorable Mention
All District 2nd Team
All District 1st Team
All City
All Area
All State
All American
2 Star
3 Star
4 Star
5 Star
Other:
School Team Awards for Primary Sport
Playoffs
District Champions
Bi District Champions
Area Champions
Regional Champions
State Champions
Other:
HUDL LINK
Your answer
YouTube or other Sports Video Link
Your answer
Parents Name
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Your answer
Parents Mobile Phone
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Your answer
Parents Email
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Your answer
Check All Programs You May Need
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Strength and Power
Mass Building and Weight Gain
Speed, Footwork, and Agility
Conditioning and Endurance
Athleticism and Performance
Toning Up and Weight Loss
College Camp or Combine Prep
Flexibility and Mobility
Injury Rehabilitation
Sports Nutrition Program
Athlete Specific Diet
General Fitness Program
Family Fitness Program
Position Specific Workouts
Sport Specific Workouts
Multi Sport Workouts
College Recruiting Services
Performance Meal Service
Team Training Program
Team / Group Seminar
Mental Focus / Structure
Other:
Required
Check All Testing and Measureables you’ve Completed within the past year.
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40 Yard Sprint
60 Yard Sprint
10 Yard Start
5-10-5 Pro Shuttle
3 Cone Drill
60 Yard Suicide Shuttle
Broad Jump
Vertical Leap
Power Ball Push
Bench Press 185 Maximum Reps
Bench Press 225 Maximum Reps
Back Squat 1 Rep Max
Back Squat 3 Rep Max
Bench Press 1 Rep Max
Bench Press 3 Rep Max
Power Clean 1 Rep Max
Power Clean 3 Rep Max
Dead Lift 1 Rep Max
Dead Lift 3 Rep Max
Front Squat 1 Rep Max
Front Squat 3 Rep Max
Push Press 1 Rep Max
Push Press 3 Rep Max
50 Meter Freestyle Swim
100 Meter Freestyle Swim
200 Meter Freestyle Swim
100 Meter Sprint
200 Meter Sprint
400 Meter Sprint
800 Meter Sprint
One Mile Run
Two Mile Run
Force Plate Jump Test
I have not completed any testing.
Required
WEIGHT LIFTING EXPERIENCE
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Beginner
Novice - Middle School
Intermediate - High School
Semi Advanced - High School
Advanced - College
Advanced Bodybuilding
Competitive Power Lifting
Pro Athlete Training
No Experience
Other:
Required
TRACK AND FIELD EXPERIENCE
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Sprints
Middle Distance
Long Distance
Field Events
Middle School
High School
College
Club
AAU
No Experience
Required
Any Limitations Affecting Your Training?
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Your answer
The Services You Want Are For Whom
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Individual
Group
Family
Football Team
Baseball Team
Basketball Team
Volleyball Team
Lacrosse Team
Softball Team
Soccer Team
Field Hockey Team
Wrestling Team
Rugby Team
Swim Team
Track Team
Cross Country Team
Tennis Team
Gymnastics Team
Cheerleading Team
Other:
Required
Tell us more about your short term needs and long range goals.
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Your answer
When is a good time and day for us to schedule a phone consultation with you?
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Your answer
Are there additional athletes, teammates, coaches, or parents you would like to refer to us? Please provide their name and contact information.
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Your answer
Terms and Conditions: This form is the sole property of Coach Philip Green, and is strictly intended for the private use by his athletes and prospective clients. Do not copy or pass on without his expressed written consent.
P.R. GREEN AND COMPANY, INC.
Copyright 2023
All Rights Reserved
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