Runner Questionnaire
Contact Information
Name *
Your answer
Address *
Your answer
Email *
Your answer
Phone(s) *
Your answer
Contact Preference *
Required
Emergency Contact
Your answer
Medical History
Date of Birthday *
MM
/
DD
/
YYYY
Gender *
Height *
Your answer
Weight *
Your answer
Is this your normal weight? *
Resting Heart Rate
Your answer
Resting Blood Pressure
Your answer
Conditions/Chronic diseases: Have you ever had any of the following: *
Required
Are you suffering from a heart Condition (hear attack, gain, irregular beat, hole in heart, etc.)? *
Do you feel pain in the chest when performing physical activity? *
Do you suffer from high or low blood pressure? *
Are you taking medications to control your blood pressure or a heart condition? *
Do you have a back or joint problem that could be made worse through physical activity? *
Do you knowingly suffer from Diabetes? *
Do you suffer from respiratory illness (asthma, bronchitis, emphysema) or have shortness of breath with mild exertion? *
Are you under medical treatment for any illness? *
For Ladies Only: Are you pregnant (or have you had a child in the last 3 months)? *
Please list any past surgeries:
Your answer
Please list any medications:
Your answer
Please list any allergies:
Your answer
Please describe any past injuries (bones, joints, muscles) and/or surgeries:
Your answer
Please describe any past treatment for injuries:
Your answer
For any existing injuries, what aggravates your injuries?
Your answer
Any (safety) issue that would affect training program?
Your answer
Do you have a history of medical issues during exercise? *
Lifestyle
What do you do for work? *
Your answer
What does your family life consist of (i.e. married, married with school age children, single with school age children, etc.)?
Your answer
What are your hobbies?
Your answer
Do you travel for work or personal?
Your answer
When do you take vacation/time off?
Your answer
What is the current number of hours per week you are exercising? *
Your answer
What is your preferred time of day to exercise? *
Your answer
Access to running (outdoor/indoor) *
Your answer
Exercise Schedule/Availability
Please indicate for each day of the week the maximum amount of time you have available to train. Feel free to break this time periods into morning, afternoon, and evening. (i.e. Monday 1hr morning lifting, 2 hours evening running)
What is your time available to train on Monday? *
Your answer
What is your time available to train on Tuesday? *
Your answer
What is your time available to train on Wednesday? *
Your answer
What is your time available to train on Thursday? *
Your answer
What is your time available to train on Friday? *
Your answer
What is your time available to train on Saturday? *
Your answer
What is your time available to train on Sunday? *
Your answer
Dietary
What is the number of meals per day you eat?
Your answer
What is your typical calorie intake (if known)
Your answer
Do you have any modified diet/restrictions?
Do you have any food preferences or dislikes?
Your answer
Do you take any dietary supplements (vitamins, herbs, minerals, protein, replacements, etc.)?
Your answer
What do you feel you need to work on?
Your answer
What do you feel you do well?
Your answer
What would you like to change?
Your answer
Psychological
Rate yourself in the following questions 1 = Poor, 2- Fair, 3= Good, 4= Very Good, 5 = Excellent
Self-Awareness
Poor
Excellent
Level of confidence to complete the A race (high priority race of the year)
Poor
Excellent
Ability to set goals and targets
Poor
Excellent
Ability to follow through with goals
Poor
Excellent
Use of visualization / imagery to prepare for a race
Poor
Excellent
Use of self-talk / through control
Poor
Excellent
Ability to pay attention / focus under stress
Poor
Excellent
Ability to endure peak sensation
Poor
Excellent
Ability to excel under pressure
Poor
Excellent
Ability to make decisions under stress
Poor
Excellent
Consistency
Poor
Excellent
Ability to take recovery days without guilt
Poor
Excellent
Feel free to comment here on any of the above responses:
Your answer
Running History
How many years of have you been running?
Your answer
Longest distance completed (what event, distance, and total time)
Your answer
Group / Organization (history, current, available)
Your answer
Coach / Instruction (history, current, available)
Your answer
Run capability (predicted)
Your answer
Number or running races completed?
Your answer
Life-Time Personal Records (PRs)
Your answer
PR's achieved over the last 12 months
Your answer
Please list any other endurance events (what, when, time/rankings)
Your answer
Other types of exercise / physical activities:
Your answer
Types of organized sports (current)
Your answer
Types of organized sports (past)
Your answer
Please list your race events for the upcoming 12 months (race name, date, and distance)
Your answer
Level of Skill (Skill Assessment)
Please indicate 1 = Novice/ Uncomfortable, 5 = Experienced/ Comfortable, N/A = Not Applicable, D/K = Don't Know
Do you like to run on roads? *
Do you have experience with track workouts? *
Do you like to run off-road? *
Do you like running hills? *
Are you able to pace yourself for long distance runs? *
Can you estimate output efforts using RPE (Zones 1-5)? *
Are you comfortable with a heart rate monitor (HRM)? *
Strength and Conditioning
Describe your current strength and conditioning program (include organized classes, frequency and duration).
Your answer
Which of the following types of equipment do you have access to? *
Required
Does your occupation require extended periods of sitting?
Does your occupation require extended periods of repeated movements? (If yes, please explain)
Your answer
Does your occupation require you to wear shoes with a heal (dress shoes)?
Equipment
Please describe the equipment you have, or any interested you may have in these items?
Running shoes (type)
Your answer
Shoelaces
Your answer
Orthotics / insoles
Your answer
Socks (type include compression)
Your answer
Race Belt
Your answer
Hat / visor
Your answer
Sunglasses
Your answer
Rain & wind gear
Your answer
Cold weather gear
Your answer
Cold weather gear
Your answer
Hydration system (preferred method)
Your answer
Food storage (preferred method)
Your answer
Heart Rate Monitor
Your answer
Watch/ Smart Watch
Your answer
GPS
Your answer
Cadence Sensor / Running Pod
Your answer
Running Power Meter
Your answer
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