Consultation Form | Shea Kerry Endurance Coach

Personal Details

First name Last name Email Phone number Date of birth Country Occupation Job demands

Goals

Main 1-3 goals Specific event, race, challenge or timeline Why do these goals matter to you? I will know this coaching has worked when...

Current Training & Experience

Current training level Worked with a coach before?

Typical current training week

Facilities access Devices and apps used Main obstacles getting in your way

Availability, Lifestyle & Nutrition

Realistic training hours per week Best days for longer sessions Most difficult days to train How predictable is your week?

Tick the days you can usually train, then add the rough times that tend to work.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Family/social commitments

Sleep Stress Energy Would you like coaching support with nutrition or habits?

PAR-Q, Health Screening & Consent

Please answer honestly. Depending on the answer, medical clearance may be required before training begins.

Emergency contact name Emergency contact phone

1. Has your doctor ever said that you have a heart condition OR high blood pressure? 2. Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity? 3. Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise). 4. Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? 5. Are you currently taking prescribed medications for a chronic medical condition? 6. Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active. 7. Has your doctor ever said that you should only do medically supervised physical activity?

General health questions from PAR-Q+ 2025, © 2025 PAR-Q+ Collaboration. Read the complete questionnaire, guidance and participant declaration. Optional screening: unanswered questions are not recorded as No. I’ll review any follow-up with you; this form does not automatically give medical clearance.

If yes to any health screening question, please give details Movements, intensities or activities you have been advised to avoid or modify

Typed name Date

Pre-call concernsAnything you are nervous about before starting?

Book Your Consultation Call

Choose from Shea’s live availability over the next seven days. Submitting this form books the selected 30-minute call in Shea’s calendar.

Available day Available time

Checking Shea’s calendar...

Nutrition Advice Questionnaire