Athlete Questionnaire - Coach Katherine
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 level. 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 address *
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Gender *
Height *
Your answer
Weight *
Your answer
Phone *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Medications *
Your answer
Any current injuries or illness? *
Your answer
Recent running injuries? If so, when? *
Your answer
How long have you been running? *
Your answer
What type of runner would you consider yourself? *
How many miles per week have you averaged over the past 3 months? *
Your answer
Describe your recent training during the last six (6) weeks - include: longest run, typical weekly mileage, speed work, type of courses (flat, hill, track, etc.), additional cross training (biking, swimming, weights, etc.). *
Your answer
Have you ever done "Speed" workouts, interval training, or effort sessions? *
Racing Experience - List the races you've completed in the last six (6) months. Include the name, distance, completion time, and date of each race. *
Your answer
Personal Bests -List your best performances at applicable distances (5k, 10k, Half, Full marathon). Include the name, distance, completion time, and date of each race. *
Your answer
Running Interests? *
Required
List your running and racing goals (future races, dates, and goal times). *
Your answer
Describe any previous problems with racing or training that you've had. *
Your answer
Why are you seeking personal coaching? *
Your answer
What days of the week are you typically available to run? *
Not Available
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
A.M. (before noon)
P.M. (afternoon or evening)
Do you run with at GPS device? If so, what brand? *
Required
How did you hear about us? *
Did someone refer you to us? If so, please provide their name.
Your answer
Please provide your social media handles (Facebook, Twitter, Instagram, etc.): *
Your answer
Would you like to subscribe to our mailing list? *
Please list any other questions, comments, or concerns that you have.
Your answer
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