Assessment - My Running Concierge

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Before you start working with My Running Concierge, please complete this form to give an accurate snapshot of your running experience. This information will help My Running Concierge put together an appropriate plan to help you meet all of your running goals.

Email *

Name *

Cell Phone Number *

Home address (Address, City, State, Country) *

Please describe your running goals. Why did you sign up to work with My Running Concierge? *

How many miles do you currently run per week? *

5-15

1-2

0-1

More than 15

2-5

How many years have you been running? *

5-15

1-2

2-5

More than 15

0-1

Please describe any injuries (either recently or from a while ago) or health concerns that may impact your ability to train with My Running Concierge *

Is there a specific race distance you want to be able to run? *

10K

Half Marathon

Marathon

No specific race in mind, I just want to improve my general fitness

Other:

Is there a specific race or event you have in mind? If no leave blank. Please specify details - event name, date, distance, etc.

What is your biggest hurdle that you foresee in trying to reach your running goals? *

Work commitments

Family commitments

Lack of motivation

Physical limitations

Other:

How do you track your running pace, distance, etc.?

I run on a treadmill

Apple Watch

Garmin

FitBit

Don't track with a watch or other tracker

Other:

Clear selection

What was the most recent race you participated in? *

Mile

10K

Half Marathon

Full Marathon

Never participated in a race

Other:

Describe details of your most recent race (finishing time, how you felt, etc.) Leave blank if you've never participated in a race.

If I asked you to complete a 5K right now, what would you estimate your time would be? *

Any other additional feedback that you feel is important to share with My Running Concierge? *

Please read and agree to the following statement before participating with My Running Concierge *

I am voluntarily participating in this Activity. I understand that there are risks associated with my participation in this Activity, such as physical and/or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, death or economic loss. These injuries or outcomes may arise from my own or other’s actions, inactions, or negligence, or the condition of the Activity location(s). Nonetheless, I assume all risks of my participation in this Activity, whether known or unknown to me, including any events incidental to this Activity, and agree to hold harmless My Running Concierge for any harm or injuries I may suffer as a result of my participation.

Required

A copy of your responses will be emailed to the address you provided.

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