Online FRC Assessment form You choose how much information you share with me. Web Site Name * Birth date E-mail address * Injuries/Illness/Pain Please fill out the following section. Choose either flexible or stiff, based on how you experience the joint. Use the text field to give more context. How often do you experience discomfort, for how long have you had the issue, how intense is the pain from 1-10, what have you done to try to fix it, why do you think you have the issue? The more info, the better. Neck No problems Flexible Stiff Painful Neck Back No problems Flexible Stiff Painful Back Right Shoulder No problems Flexible Stiff Painful Right Shoulder Left Shoulder No problems Flexible Stiff Painful Left SHoulder Right Shoulder Blade No problems Flexible Stiff Painful Right Shoulder Blade Left Shoulder Blade No problems Flexible Stiff Painful Left Shoulder Blade Right Elbow No problems Flexible Stiff Painful Right Elbow Left Elbow No problems Flexible Stiff Painful Left Elbow Right Wrist No problems Flexible Stiff Painful Right Wrist Left Wrist No problems Flexible Stiff Painful Left Wrist Right Hip No problems Flexible Stiff Painful Right Hip Left Hip No problems Flexible Stiff Painful Left Hip Right Knee No problems Flexible Stiff Painful Right Knee Left Knee No problems Flexible Stiff Painful Left Knee Right Ankle No problems Flexible Stiff Painful Right Ankle Left Ankle No problems Flexible Stiff Painful Left Ankle Right Foot No problems Flexible Stiff Painful Right Foot Left Foot No problems Flexible Stiff Painful Left Foot Anything else you feel like adding? How would you describe your general health? Very good Good Okay Bad Do you have any illnesses you want to mention? Training What is your training background? Are you using any program right now? A running program A strength program A sport specific program No What equipment do you have at home? How much time can you realistically use for training? Think about blocks of time at least 20-30 minutes. What do you want to train besides mobility, and how often? Please describe your training week. How often do you want to train, and what types of training do you want to include, etc? Lifestyle How active are you during your free time? Little or no activity Moderate physical activity 1-3 times a week Moderate physical activity more than 3 times a week Hard physical activity more than times a week How active are you at work? Sedentary Some activity Active Very active How active are you at school Sedentary Some activity Active Very active I usually sleep under 6 hours per night between 6 and 7 hours a night between 7 and 8 hours a night more than 8 hours a night Livestyle I go to bed and wake up at the same time every day My sleep quality is good I smoke I drink alcohol I feel tired and lack energy during the day I have a partner I have a kid How tall are you in cm? Google "feet to cm" if you don't know How much do you weigh in kilos? Google "lbs to kg" if you don't know What's your fat percentage? Diet This section is optional Which meals do you eat during the day? Breakfast Lunch Dinner Evenings Snacks What are your biggest challenges with your diet? I feel hungry I eat to much I don't eat enough I eat to much fast food Cravings A long term healthy diet Kosthold I eat at least 500gr of fruits, berries and vegetables daily I drink 1,5-2L water daily I drink more than 3 cups of coffee daily I drink coffee after 5 pm I drink sugary drinks regularly I drink energy drinks regularly Matvalg I'm a vegetarian/vegan I eat low carb / keto I have allergies / intolerances I'm very picky I follow a specific diet What do you eat in a normal day? Goals Which 3 factors are the most important to you? To look better Get more energy through out the day Better health Get stronger Better conditioning Feel like my body works better Less pain Find the joy of training Mer visible muscles Loose weight Gain weight A softer body Goal for your mobility training Long term health goal Personal Assessment What expectations do you have towards the coaching? Have you had a personal trainer before, or used an online coach? If yes, when and how was the experience? Ready to send? Ja
