Running Rehab Participant Form
In order to help you achieve the greatest benefit from your Running Rehab session, we need to know a little more about you. Please take a few minutes to complete this form.
Name *
Date of Birth *
MM
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DD
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YYYY
Email address *
Occupation *
Do you have any current injuries? *
If yes, please give further info: (e.g. where is the pain, when did it start, have you made any changed to your training schedule, running style, running footwear/insoles recently, are you returning to running after break, have you had any previous injuries which have affected your running?)
How far can you run before you experience any pain?
What happens if you keep running? Pain gets:
Clear selection
How quickly does the pain stop when you stop running?
Clear selection
Do you have any specific running/sports goals or events coming up? *
Why do you run? (enjoyment/stress relief/weight loss etc) *
What is your normal weekly running/exercise schedule? *
Required
Please provide further details of the type of training you do, including low/medium/high intensity or a specific type of training such as hill training or interval/speed session, on each day.
Have you made any changes to your training schedule recently? *
General Health
Do you suffer with any of the following?
Heart problems? *
Asthma? *
Thyroid problems? *
Rheumatoid Arthritis? *
Epilepsy? *
Diabetes? *
Osteoporosis? *
Previous surgery? *
Pregnant or recently given birth? *
If you have answered yes to any of these questions, please provide further details.
Thank you
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