OLYMPIC WEIGHTLIFTING

PERFORMANCE TRAINING

Do you hve any major health conditions? (PLEASE SELECT ALL/ANY THAT APPLY)

Cardiac/Cardiopulmonary

Chronic Stress

Metabolic Condition

Cognitive Disruption (i.e. head trauma)

Psychoemotional (optional to answer)

Other

Please descibe conditions selected to the best of our ability asthey pertain to exercise & fitness.

Do you currently take any contraindicating medications?

YES

If yes, please list and briefly describe prescription/dosage/side effects you experience.

Please identify any injury sites/problematic areas and briefly describe how they affect you:

Primary Training Golas:

How long have you been training with consistency (i.e. 3 or more days/wk)?

0-6 months

6-12 months

1 year +

How would you describe your current strength/conditioning/ability?

Worst shape I've ever been in

About where I want

Best shape I've ever been in

Please briefly describe your training history and what you are looking to get out of Rude Rock Remote:

Please select if you do NOT have accessto te following equiment:

Hex Bar ("trap bar")

Barbell

Landmine Rig

Sled

Resistance Bands

Please briefly describe what your training situation looks like (i.e. commercial gym, home gym, etc...)

How did you hear about us? Have you used remote coaching before? If so, how was your experience?

Thanks for submitting!

DAN

OVER 1K VIDEOS!

NIC