Online Consult Questionnaire
Thank you for your interest in an online performance consult with Taylor! This questionnaire is the first step to requesting a consult, and your thorough answers help Taylor ensure your consult experience is valuable to you!
Email address *
Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
Height (inches) *
Your answer
Weight (lbs) *
Your answer
What are your current training goals? *
Your answer
What do you think are current or potential obstacles to your training goals? *
Your answer
Describe your current training. *
Your answer
What do you hope to gain from this online consult? *
Your answer
How willing are you to modify your current training? (0= not at all, 10 = eager for a total overhaul) *
To what extent is your training limited by pain? (0 = not at all, 10 = unable to train at all) *
Have you ever had any surgeries? (If yes, please explain.) *
Your answer
Please provide a history of pain and/or injuries (please include month and year to the best of your ability, eg: “March 2016- left ankle sprain”) *
Your answer
Are you currently being treated by a licensed healthcare professional for training related pain? (Eg PT, chiro, athletic trainer) *
Has a healthcare provider ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes? (If yes, please explain.) *
By selecting yes, you acknowledge that the information provided above is correct, and that you understand that online consults only include services typically provided by a strength coach (CSCS) and that this consult is performance-oriented and in no way telemedicine or physical therapy services. *
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