Custom Programming Intake

Athletic History
Please tell us about your past and present athletic activities*
Add more rows with the + if needed.
Sport/Activity Years of Participation Additional Details or Info

Training History
Please tell us what your training regiment has consisted of over the last 6 months*
Do you currently have a warm up that you do consistently?*
- Yes
- No
Please tell us about your warm up*
Do you currently have a recovery plan post workout?*
- Yes
- No
Please tell us about your recovery plan*
Do you currently work on mobility outside of your warm up / recovery plan?*
ie Rest days, specific mobility days, ROM WOD
- Yes
- No
Please tell us about your mobility work*

Goals
What athletic goals do you have (long or short term)?*
How many days a week would you like programming for?
How much time can you allot to training each day?
Will HELIYO programming be your only training or do you plan on having additional forms of exercise?
- Yes
- No
Please describe all other training activities in addition to HELIYO programming

Lifestyle
What is your occupation?*
Different occupations effect the body in varying ways, this will allow us to customize your warm ups and training accordingly.
Do you currently follow a nutritional plan?*
- Yes
- No
Please describe your current nutritional plan?*
What is your preferred method of communication with HELIYO?
- Text
- Email
- No Preference

Surgeries and Medical Procedures
Have you experienced an surgeries/medical procedures in the past?*
- Yes
- No
Please list all surgeries and/or medical procedures below*
Add more rows with the + if needed.
Date of Surgery/Procedure Type of Surgery/Procedure What Cause/Event Lead to This? Resolved or Ongoing Condition?

Injuries
Have you experience any injuries in the past?*
Injuries involving muscles, tendons, ligaments, and bones
- Yes
- No
Please list all injuries below*
Add more rows with the + if needed.
Date of Injury Type of Injury How Did Injury Take Place? Resolved or Ongoing?

Serious Health Conditions
Have you experienced any serious health conditions in the past?*
- Yes
- No
Please list all health conditions below*
Add more rows with the + if needed.
Date of Health Condition Type of Health Condition Resolved or Ongoing Condition?
Do you have any additional health information that you would like to disclose?*
- Yes
- No
*

Current State of Your Body
Are you currently experiencing any aches and/or pains?*
- Yes
- No
Please list all aches and/or pains*
Add more rows with the + if needed.
Location Description of Pain/Ache Date of Onset How did it start?
Does a physician or physical therapist currently monitor or prescribe exercises for you?*
- Yes
- No
If yes please describe who and what for*
Anything else you would like to tell us about the current state of your body?*
- Yes
- No
If yes, please elaborate*

Athletic History