Performance Training Intake

Performance Training Intake

Patient Acknowledgements
Please read the linked forms below before signing.
By signing below, you agree to the terms listed in the "Patient Acknowledgement and Consent" form: *

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By signing below, you agree to the terms listed in the "No Show, Cancellation, and Late Arrival Policy": *

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Required IF being treated via Telehealth.
By signing below, you agree to the terms listed in the "Telehealth Consent" form:

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Optional
By signing below, you agree to the terms listed in the "Photo/Video Consent and Release" form:

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Optional (print, complete and bring to first appointment)
By signing below, you agree to the terms listed above:

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2/5

Performance Training Intake

History of Current Condition
Please shade in any areas you think might be limiting your performance: *
Briefly describe any flexibility, strength or other issues you think might be limiting your performance.
Do any aspects of your training seem to make the above areas worse?
Do any aspects of your training seem to make the above areas better?
What athletic activities do you currently participate in?
How long have you been participating in these activities?
I am currently training number of days days per week for a total of number of hours hours per week.
Briefly describe what your training consists of.
Do you have a coach and/or trainer?

Yes No
If so, who is your coach and/or trainer?
Do you have any current pain, aches or discomfort?

Yes No
If yes, explain.
What do you hope to accomplish with performance training?
Do you have any particular upcoming games or events that you are training for?

Yes No
If yes, what game or event and when?
Is there anything else that you would like for us to know?
4/5