Get Coached: 

Be thorough with your answers, the more information the better!  Don't worry this test isn't graded. 

 

Name *
Name
Full Name
Date of Birth *
Date of Birth
Phone *
Phone
Address
Address
Preferred Primary Coach *
At IREP we believe in a team centered approach to coaching. However, one coach typically will act as the primary facilitator choose one below.
We can customize this as needed if you do not have a regular schedule
Weekly, monthly, bi-monthly, three month increments, etc...
Health History/Symptoms/Health issues *
Checking a box indicates that you have had that sign or symptom.
Cardiovascular Risk Factors *
Checking a box indicates that "Yes" you have that sign or symptom
Waiver and TCI
Terms, Conditions,Informed Consents, and Media Release (TCI). Must check all . Submitting this form is also an acknowledgement that you agree to all of the below (downloadable copies available at bottom of this page):