1-1 Remote Coaching Application
If you are interested in 1-1 remote coaching, please complete the form below and we will be in touch within 48 hours.
Email Address *
Your answer
First & Last Name *
Your answer
Gender *
Birth date *
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What are your training goals? Be sure to include both short term (3 months from now) and long term (1 year from now) *
Your answer
Specific areas looking to improve *
Required
Do you currently have an injury or have you had any injuries in the last 6 months? *
Have you seen a medical professional for this injury? If yes, please describe the injury and which medical professional you are currently seeing and the treatment you are receiving *
Your answer
Have you ever had surgery? If so, please explain procedures *
Your answer
Are you currently taking any medications? If so, which ones? *
Your answer
Have you ever been dizzy or fainted during/after exercise? If yes, please describe *
Your answer
Have you ever had chest pains during/after exercise? If yes, please describe below *
Your answer
Have you ever had high blood pressure? If yes, please describe below *
Your answer
Do you have a heart murmur or other heart condition? If yes, please describe below *
Your answer
Have you ever had a seizure? If yes, please describe below *
Your answer
Do you ever have any trouble breathing during/after exercise? If yes, please describe below *
Your answer
Do you wear any glasses, contacts, or protective eye-wear? If yes, please describe below *
Your answer
Have you had any problem with your eyes or vision? If yes, please describe below *
Your answer
Have you had any other medical problems (asthma, diabetes, etc.)? If yes, please describe below *
Your answer
Have you ever sprained, broken, dislocated, had repeated pain or swelling of any bones or joints? If yes, please describe below *
Your answer
What equipment do you have available? *
Required
How many times per week can you CONSISTENTLY train? *
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This form was created inside of Evolution Athletics.