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.
Email *
Today's Date *
MM
/
DD
/
YYYY
Name (First Last) *
Age *
Sex
Height
Weight
Phone *
Communication Preference (select one or more) *
Required
Location (City, State Zip) *
Emergency Contact (Name and Phone) *
Current State of Health *
Medications (Write n/a if none) *
If currently sick or injured, describe difficulty and date of onset:
Health Risks (i.e. family history, chronic disease, etc.): *
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? *
What does a typical fitness week look like for you including and outside running? *
Have you ever done "speed" workouts, interval training, or "effort sessions"? *
If you answered yes to the above, describe. Otherwise write "n/a". *
Recent or Chronic Running Injuries: *
Describe any problem with previous training or racing: *
Most recent racing results - include distance, pace/time, and date: *
Describe your current training goals. What are you trying to accomplish and by when? *
Running Personal Bests - Mile/1500, 5K, 10K, Half Marathon, Marathon, Other - Include Time and Year *
Additional comments or concerns:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms