Precision Cycle Coach, a cycling coach, offering training and coaching services for cyclist and bicycle racers. A smarter way to train.

Ready to get started? Print out this page, or copy and paste into a Word document, fill it out (the more information I have the better) and mail or email it to me, along with your $500 payment for the first 2 months.

If you have any questions about the interview form contact me, I will be happy to walk you through the process.

I look forward to working with you!

Precision Cycle Coaching

Basic Information

Name_____________________________________________________

Street __________________________________________________________________Apt.__________

City ____________________________________________State________________Zip______________

Phone: Home (______)____________ Work (______)____________ Mobile (______)_______________

Best Place to call you_______________________________________________________

Best Times to reach you________________________________________________________

Fax (______)____________ E-mail Address______________________________________

Gender ________M________F

Birthday ______/______/______ Age ______ Weight ______Height______

How do you prefer to receive workouts? On-line_____ Fax_____ E-mail_____

I consider myself a ______ Racer (Road Category _____ Norba Category _______ Track Category___)

______ Recreational Rider (ie: train for 60-100 mile rides)______ Fitness Rider (ride to stay in shape)

______ Other (please explain___________________________________________________)

How did you hear about Precision Cycle Coaching? Referred by__________________ Website________

Other_______________________(please clarify)

Occupation _______________________________ Hours worked weekly_________

Same hours each week?_____ Very stressful?_______ Stressful?________ Not Stressful?_______

Hobbies _________________________________________________________________________

Married? _______ Spouse's Name________________ Children?____________________________

What kind of support do you have from family/friends in helping you reach your goals?

__________________________________________________________________________________

Your Athletic Background

1. What is your background in endurance sports (# years training/ # of years competing)?

______________________________________________________________________________________

2. What is your background in other sports (include the # years training/competing for each)?

______________________________________________________________________________________

3. Have you ever had an exercise-related injury that caused you to stop exercising for a week or more? Please describe.

______________________________________________________________________________________

4. Please list your best competitive results and race times (if appropriate).

Events Result

________________________ ____________________________________________________

5. Are there any other accomplishments you would like me to know about?

______________________________________________________________________________________

Current Fitness

1. Rate your current fitness level (1=worst shape, 10=best shape)______

2. What is your current resting heart rate (taken in the a.m.)?__________

3. Do you train with a heart rate monitor?__________ If so, which brand/model?__________________

4. Do you train with a power meter?____________ If so, which brand/model?____________________

5. What is the maximum heart rate you have seen in the last 6 months?________

6. What was the type of exercise when you noticed the above pulse?___________________________

7. Do you know your VO2 Max?________ When/where tested?________________________________

8. Do you know your Lactate Threshold Heart Rate?______ Your Lactate Threshold Power?________

How/when was this determined?_______________________________________________________

9. What was your average Heart Rate for your last difficult Race/Ride (approx. 1 hr long)?___________

10. List your average HR/distance/average power (if you have a power meter) for as many of the following events you have participated in during the last year:

_____/_______/_____ short TT, _____/_____/______medium TT, _____/______/_____ long TT,

_____/_______/_____criterium, _____/_____/____road race, _____/_____/____mtn. bike race,

_____/_______/_____century, _____/______/____group ride ____/_____/_____other (________)

11. Please list your greatest cycling strengths (include physical, mental, tactical,etc.)_______________

______________________________________________________________________________________

12. Please list your greatest cycling weaknesses (include physical, mental, tactical etc.)_____________

______________________________________________________________________________________

14. Please describe your current diet and your understanding of sports nutrition?____________________

_______________________________________________________________________________________

Your Goals

1. What are your three most important goals as a cyclist? Please list by priority.

1. ________________________________________________________

2. _________________________________________________________

3. ________________________________________________________

2. What commitments are you willing to make to reach your goals?

________________________________________________________

3. Why specifically are you seeking the advice of a coach?____________________________________

_____________________________________________________________________________________

4. What is the most important thing we must accomplish this season?

______________________________________________________________________________________

5. Goal Events

List (in order of importance) races/events in which you plan to compete, along with realistic goals for each.

Race/Event Date Distance Goals

_____________________________ _____________ _____________ _________________________

Your Schedule

1. Do you keep a training log? ______

*Please submit (1 pg. only) a general overview of last year's training plan (if you had one).

2. How many days per week can you train? ______ How many days per week do you train now? ______

How many hours per week do you have available to train? ______

3. List the number of hours and time of day you are available to train (ie. 5 -7:00 a.m. /6:30-8:00 p.m.):

Mon.___________________________________ Tues.________________________________

Wed.___________________________________ Thurs._______________________________

Fri._____________________________________ Sat._________________________________

Sun.____________________________________

4. During the week, do you prefer to workout in the a.m._____, p.m._____, either_____, or both________?

5. Please give an idea of your typical training week. Be as detailed as possible.

(Type of workout, How Long, Intensity: Low/Med/High)

Monday _________________________________________________________

Tuesday _________________________________________________________

Wednesday________________________________________________

Thursday _________________________________________________________

Friday _________________________________________________________

Saturday _________________________________________________________

Sunday _________________________________________________________

Is the above ______high ______low ______normal for you?

6. What is the best day for you to take off from training? (Circle one) M T W Th F S Sun

7. What is your longest training session during the past month?

Cycling_____hours _______mi/km Cross Training (please specify)_____________hours__________

8. Over the past two months, what is the average number of hours per week you trained?

Cycling ____________________ Cross Training (please specify)_______________ hours__________

9. How many races/events did you compete in last year?____________________

How many do you expect to compete in this upcoming year?______________

10. What kind of workouts do you enjoy the most? _____________________________________________

_______________________________________________________________________________________

11. Are there any regular group workouts that you participate in? __________

If yes, please list and describe the workouts as accurately as you can (i.e. time, intensity, time of day, time of year, type of terrain, size of group)

______________________________________________________________________________________

12. Are these group rides enjoyable to you? yes_____no _____sometimes_____ doesn’t matter to me___

13. What is the most fun you have had riding a bike?___________________________________________

______________________________________________________________________________________

14. How many years have you lifted weights?____________ Describe your current strength training routine (reps/sets, # of days, exercises):

________________________________________________________________________________________

What equipment do you have available? ______________________________________________________

15. How often and how much time do you spend stretching?_____________________________________

16. Where can you train? Road_____Off Road_____ Indoors_______ Other ___________

17. What brand/model of cycling trainer do you have?_______________________________________

How do you feel about spending time on it?_____________________________________________

18. What type of terrain do you have available?

Flat_____ Rolling Hills_____ Steep Hills_____ Long Hills_____

Mountains_____ Fire Roads_____ Trails_____ Technical Trails_____ Other___________________

19. What are the gears on your bike? Front chain rings_________Rear derailler cogs_____________

20. Are you interested in personal "shoulder to shoulder" training with your coach?_________________

Medical

1. Are you currently under the care of a physician? Yes _____ No _____

If yes, please explain: ____________________________________________________________

_______________________________________________________________________________

2. Are you taking any medication? Yes _____ No _____

If yes, please list: _______________________________________________________________

______________________________________________________________________________

3. Have you had a complete physical in the last year? Yes _____ No _____

Weight________ Ideal Weight_______ Height__________ %Body Fat______________

4. Smoke? Never____ Quit over a year ago ______ Quit less than a year ago _______

Currently smoke _______

5. Please mark with an X all of the following that apply to you. Please explain in the space

provided, or on a separate sheet:

_____Have you or anyone in your family had coronary artery disease?

_____Have you ever fainted or felt dizzy after exercise?

_____Has a doctor said that your blood pressure is too high?

_____Do you have heart trouble, a heart murmur or have you had a heart attack?

_____Have you ever had a complete physical exam, including stress test on a treadmill or ergometer?

When?______________Please attach a copy of your results.

6. Do you ever have chest, shoulder, neck or arm pains during exercise? Yes ____No____

7. Are you diabetic, have a thyroid or any other chronic condition? Yes____ No ____

8. Is your cholesterol level high? Yes____ No____

What is your cholesterol count? ________ What is your HDL level?____________

9. Are you now or have you been pregnant in the last three months?

Yes_______ No_________

10. Have you ever had a joint or back disorder or any current injury? Yes____ No_____

If so, please explain____________________________________________________

_________________________________________________________

11. Have you had surgery in the past 12 months? Yes____ No__________

If so, for what?_____________________________________________________

____________________________________________________________________

12. Do you have any conditions that your doctor says may limit your physical activity?

Yes______ No______

If so, please explain____________________________________________________

____________________________________________________________________

13. Do you have any conditions that you think may limit your physical activity?

Yes______ No______ If so, please explain__________________________________

____________________________________________________________________

*Please consult your physician before starting this or any exercise program.

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Athlete Waiver and Release

Your signature is required

I acknowledge that training for and/or participation in a cycling, running, adventure race, triathlon, or other endurance sport event can be an extreme test of a person’s physical and mental limits and such training or participation poses potential risks of serious bodily injury, death or property damage. I HEREBY AGREE TO EXPRESSLY ASSUME AND ACCEPT ALL RISKS OF INJURY OR DEATH.

Please initial_____________

I agree to the following (initial statement to which you agree at the "initial" space):

(Initial)_________ Precision Cycle Coaching has been retained to assist me in the improvement of my fitness.

(Initial)__________I hereby attest that I am in good health and suffer no condition, impairment, disease, infirmity or other illness that would prevent my participation in these activities. I attest that my physical condition has been verified by a licensed medical doctor.

(Initial)__________In consideration of being accepted as a client by Precision Cycle Coaching, I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns, or anyone else who might claim or sue on my behalf:

a. Waive, Release, and Discharge Precision Cycle Coaching and its Owners, Officers, Directors, employees, administrators, consultants, coaches and agents from any claims, costs or liabilities for personal injury, illness, death or damages of any kind which I may have now, or at any time in the future, resulting from training for and/or participation in any cycling, running, adventure race, triathlon, or other endurance sport event.

b. Agree not to Sue any of the persons or entities mentioned above for any claims, costs or liabilities that I have waived, released or discharged herein.

c. Indemnify, Defend, and Hold Harmless, the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions.

(Initial)_____I am solely responsible for my debits and agree to pay for services no later that the first day of each 4-week coaching period. I agree to pay collection fees if my debits are 15 or more days overdue. I understand that my initial Client Start-Up Fee and current month’s coaching fee is non-refundable. It is my responsibility to initiate phone calls to my coach and I will pay for any long distance phone charges.

(Initial)_____I am retaining Precision Cycle Coaching to coach me at a rate of _________per month. (One month equals 4 weeks). I understand that my commitment is for ________ months from the dates______________ , 20_____ to _________________, 20____.

(Initial)____I affirm that I am eighteen (18) years of age or older, I have read this document and understand its contents. (Athletes under the age of eighteen must have parent or guardian sign.)

Printed Name_______________________ Signature____________________________________

Date___________________________

Parent or Guardian Signature________________________________Date___________________

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PLEASE return this form with your Client Start-Up Fee of $550 for 2 months coaching services payable to: Precision Cycling.

After I receive your packet, you will be contacted to discuss this information further and will be given a start-up date to begin your first month of coaching. Thank you for taking the time to fill out this information. I look forward to working with you!

Precision Cycling

708 Harris Ave

Valdese NC 28690

828-432-6266

Once I receive your package I will contact you within 48 hours.