Athlete Questionnaire
In order to help us plan a fitness/athletic program for you, it is necessary to evaluate some of your health and lifestyle history, as well as your present running fitness. Please answer to the best of your ability. Your information will be kept confidential and used only in helping make recommendations for a fitness program.
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Email *
Today's Date *
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Name (First Last) *
Your answer
Age *
Your answer
Sex
Your answer
Height
Your answer
Weight
Your answer
Phone *
Your answer
Communication Preference (select one or more) *
Required
Location (City, State Zip) *
Your answer
Emergency Contact (Name and Phone) *
Your answer
Current State of Health *
Your answer
Medications (Write n/a if none) *
Your answer
If currently sick or injured, describe difficulty and date of onset:
Your answer
Health Risks (i.e. family history, chronic disease, etc.): *
Your answer
Running Interest (check all that apply) *
Required
Running Racing Experience (select one) *
How many miles per week have you averaged over the past three months? *
Your answer
What does a typical fitness week look like for you including and outside running? *
Your answer
Have you ever done "speed" workouts, interval training, or "effort sessions"? *
If you answered yes to the above, describe. Otherwise write "n/a". *
Your answer
Recent or Chronic Running Injuries: *
Your answer
Describe any problem with previous training or racing: *
Your answer
Most recent racing results - include distance, pace/time, and date: *
Your answer
Describe your current training goals. What are you trying to accomplish and by when? *
Your answer
Running Personal Bests - Mile/1500, 5K, 10K, Half Marathon, Marathon, Other - Include Time and Year *
Your answer
Additional comments or concerns:
Your answer
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