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ATHLETE SERVICES
1:1 TRAINING
GROUP TRAINING
YOUTH
TECH SOLUTIONS
COACHES
COMPANIES
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Name
*
First
Last
Date of Birth
*
Height
*
In inches
Weight
*
In pounds
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?
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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)?
*
Movements
Please tell us about movements you LOVE and why you LOVE them
Please tell us about movements you HATE and why you HATE them
Lifestyle
What is your occupation?
*
Different occupations effect the body in varying ways, this will allow us to customize your plan of care 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
*
*
I've read and accept HELIYO's
terms of service
.
*
I have completed and would like to submit my intake
Signature
*