At Empower Coaching Systems, our mission is to understand your needs and aspirations as an athlete, and then develop a strategy that will help you achieve your goals in the safest, most effective manner possible.  The Athlete Questionnaire allows us to better understand you, reveal some of your goals, and learn what you hope to get out of hiring a personal coach. Please complete this entire questionnaire and elaborate fully.  The more information we can gather from you, the better we will be able to fit you with a coach to help you achieve your dreams.  Kindly fill out the questionnaire and an Empower Coach will get back to you within 12 to 24 hours after submission.  Thank you for your interest in Empower Coaching Systems.
A few basic questions:
Name
Current Address
Age, (birthdate) Height and Weight
Home Phone and Cell Phone
E-mail Address
Highest Heart Rate you have seen on your monitor this year.
Do you have a power meter on your bike? If so, what kind?
How did you hear about Empower Coaching Systems?
Do you have a specific Empower Coach in mind that you would like to work with?
To win a race you must know where you are starting. Prior to the development of any training strategy, we focus on your personal situation and current level of fitness. We believe that your performance is an evolution. With that in mind, please answer the following:
How long have you been riding? 
How long have you been racing, (if you race) and what category are you? 
If you had to make an estimate, how many miles do you think you rode last year (if you do not have a training log to refer to)?
How many hours a week do you want to devote to training?
Are you open to getting some physical testing done (i.e. a Lactate Threshold Test, VO2 Max Test, Field Testing)?
Our mission is to understand your needs and aspirations, and then develop a strategy that will allow these goals to be achieved in the safest most effective method possible. With this in mind, please answer the following:
What are your short-term goals for cycling (i.e. fall and winter training)? 
What are your goals for next season? (performance goals and personal goals in cycling)
What are your long-term goals for cycling?
What do you most want to get out of hiring a coach?
Successful athletic performance is built on a strategy and involves long range planning that focuses on the big picture. By us taking a long-term interest in you, we will hopefully develop a deep and mutually respectful relationship based on trust. We will develop a strategy and tactics, which are mandatory for producing substantial long term, and short-term results. With this in mind, please answer the following:
What do you feel your commitment to a cycling program is on a scale from 1-10, with 10 being the highest level of commitment?
How does cycling fit into your daily life?
If you were to prioritize the important things in your life, where would cycling fit in?
What is the most important aspect of cycling to you? What do you love the most about the sport?
Why did you start to ride?
Why do you continue to ride/race?
What is your favorite ride?
Nutrition and supplementation is an important part of any training plan. In addition, we need to know a brief medical history to devise a safe and effective training plan for you.
Have you ever followed any diets? If so, what kind and how did your body respond?
Do you use any supplements? What kind and when?
Do you use any kind of medication? What kind and when?
When was the last time you had a blood test done? Why?
Have you been sick lately? What did you have?
Have you ever had any type of injury or surgery? What type and when?
Do you have any type of allergies? Do you use medication?
If female, are you on any hormone based birth control?
Your mental preparation and mental “game” will be a big part of what we include in your coaching package. With this in mind, please answer the following:
Have you ever worked with a sports psychologist and how did you like the results?
Have you ever seen a professional therapist for any reason, and if so, what did you learn from him/her?
Have you ever done any mental toughness training and if so, how did you like it?
Do you feel your mental “game” is strong, needs work, or does not play a factor in your performance?
Do you feel your mental preparation, or lack of mental prep, plays a roll in your performance?
Last, but not least, a few more general questions!
What type of bike do you ride? What components do you have?
Do you stretch? What kind of stretches?
What do you do for work? What are your working hours? Do you sit or stand at work? Is there stress involved?
Do you have a family at home? Husband, wife, kids, boyfriend, girlfriend?
What is your sleeping pattern like? Do you have trouble sleeping?
Do you like to eat, party, socialize? How often?