PERFORMANCE TRAINING QUESTIONNAIRE

SCSP PERFORMANCE TRAINING QUESTIONNAIRE

This is your first step in the pursuit of your goals with Sean Cochran and his performance training programs. The information you provide is very important as it will be used by Sean to develop your individualized training program. All answers you provide will remain confidential.

Once the questionnaire is completed, the information will be sent to Sean. Sean will contact you via email to confirm receiving your questionnaire, ask any additional questions he may feel are pertinent to your success, and schedule your in‐person assessment. Sean is looking forward to assist you on your journey and the reaching of your goals.

Let’s get you started on a better you.

Goals & History

Medical History

First Name *
Last Name *
Emergency Contact Cell *
Do any of the following apply to you?
- Previous serious injuries

- Chronic pain (knee, back, shoulder, etc.)

- Surgeries

- Coronary heart or artery disease

- Hypertension (high blood pressure)

- High cholesterol

- Diabetes

- Taking medication or supplements

- Any medical conditions SCSP staff should be aware of
YesNo
If "Yes" explain:

Physical Activity Readiness Questionnaire (PAR-Q)

Do any of the following apply to you?
- Heart condition

- Only perform physical activity recommended by a doctor

- Feel chest pain when you perform physical activity

- Lose your balance because of dizziness

- Lose consciousness

- Bone or joint problem made worse by physical activity

- Diabetes

- Take medication for blood pressure or heart condition

- Any reason why you should not engage in physical activity
YesNo
If "Yes" please explain:
If you have answered "Yes" to one or more of the above questions, consult your physician BEFORE engaging in physical activity. Tell your physician what questions you answered "Yes" to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. *
I acknowledge I have read & understand this section

Training Waiver

Initial after reading each statement
I understand certain elements of this program can be physically demanding and I accept full and complete responsibility for my own ability to healthfully participate in this program. If I have questions or concerns regarding my physical ability to participate in an exercise program I will contact my personal physician prior to commencing in an exercise program. *
I understand it is the recommendation of the American Heart Association and Sean Cochran Sports Performance that anyone over the age of 35 years consult his/her physician prior to engaging in a vigorous exercise program. *
I agree to assume all risk of personal injury (including death) occurring or sustained while traveling to, attending or participating in this program, or any instruction or other activities associated with my participation or practice in this training program. *
I agree to hold Sean Cochran Sports Performance, SCSP Coaches, interns and any other training staff or facility which I'm using or participating at, free from any and all loss or liability for any accident or injury, fatal or otherwise, which may result directly or indirectly from my involvement in this training program. *
I, willingly and knowingly, assume for myself and my heirs, family members, executor, administrators, and assignees any risk that is associated with my participation in this training program. *

Professional Agreement

Initial after reading each statement
I am aware that what I am embarking upon is not a quick fix in any way, but rather a narrow winding pathway to achieving my goals. I recognize that the greatest personal rewards derived from pursuing the achievement of my goals are the result of my own hard work, dedication, and perseverance. I accept that my involvement is a long-term commitment and will require a considerable effort on my part in order to achieve my goals. I understand that failing to implement any part of my program will reduce my chances of success. *
I understand that if at any point, for any reason, either the SCSP Coach or myself (trainee) may decide to end the training relationship with a 30-day notice. I understand that if I do not give at least a 30-day notice of ending my training with SCSP if I have an auto-pay plan that I will be charged a final time. Plans are not able to be paused due to missed workouts. If a substantial injury occurs we will review on a case by case basis. In addition I understand that any disrespectful behavior towards SCSP employees is unacceptable and is grounds for immediate termination of the training relationship without a refund. *

Verification

Please enter any two digits *Example: 12
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Please fill out our quick intake form in order to get in touch with the SCSP staff.

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Step 1 of 3

Name*

Email*

Phone*

Location*

Performance Training Questionnaire