COACHING CLIENT INTAKE FORM

Full Name

Date of Birth

Day

Month

Year

Gender

Email Address

Phone Number

Address

Emergency Contact Information

Full Name (Emergency Contact)

Relationship to You

Emergency Contact Phone Number

Health and Medical History

Please provide details of any diagnosed medical conditions.

Please provide details of any injuries or persistent pain (e.g. knee, back etc)

Please provide details of any prescribed medication currently taken.

Please provide details of any allergies.

Have you been advised by a medical professional to avoid certain physical activities?

Yes

No

If yes, please provide details

Running and Athletic History

How long have you been running?

0-1 years

1-3 years

+3 years

Have you run an ultra marathon before?

Yes

No

If yes, please provide details of previous ultra marathons

Please list your personal best times for the following distances

5km

10km

Half Marathon

Marathon

Ultra Marathon

Provide details of any other sports or physical activities you participate in

Training and Goals

What are your primary goals for working with a coach?

Please provide details of any races you have planned

What are your top three process goals

These are actions you need to do to improve your running. Think "how" rather than the outcome i.e. improve hill strength / race day nutrition / trail speed

What are your top three performance goals

These goals are focussed on the outcomes of your running efforts. They are about measurable results i.e. Completing an Ultra / Running a personal best / Winning a goal race

Describe what a typical running week looks like for you

How many hours per week do you have available to train

0-4hrs

4-8hrs

+8hrs

Preferred time of day to run

Morning

Afternoon

Evening

What do you believe are your top 3 strengths as a runner

What do you believe are your top 3 weaknesses as a runner

Lifestyle & Preferences

What is your occupation

Describe your typical work day

Do you follow a specific diet or have any dietary restrictions?

How many hours sleep do you get on average per night?

Less than 4hrs

4-8hrs

More than 8hrs

How you typically train

Alone

Run Club

Training Partner

Additional Information

Do you train with a GPS watch?

Yes

No

Do you train with a Heart Rate Monitor

Yes

No

Do you prefer to work in Kilometres or Miles?

Kilometres

Miles

Which coaching style do you respond best to?

Is there any other information you think would be helpful for your coach to know?

Agreement and Consent

I acknowledge and agree to the following:

I understand that the information provided in this form will be used by my coach to create a personalised training plan and that it is my responsibility to keep my coach informed of any changes to my health, medical condition, or personal information

By participating in this coaching program, I understand that running and endurance training carry inherent risks, including but not limited to injury, illness, and physical exertion. I confirm that I am voluntarily engaging in this training and assume full responsibility for my health, safety, and physical condition. I release my coach and any affiliated parties from any and all liability for injuries or health issues that may arise from following the provided training plans or advice. I understand that this coaching is not a substitute for medical advice and that I should consult a healthcare professional before beginning or modifying any exercise program.