PSW_ Run Coach
Run Coaching Athlete Questionnaire
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In order to help me plan a fitness/athletic run 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/running program.

First Name | Last Name *
Email *
Address *
Phone number *
Emergency Contact (name | phone number | relation) *
Birth Date *
Marital Status *
Occupation *
Current state of health. List any medications.  *
If currently sick or injured, describe difficulty and onset date *
Have you ever been treated for an emotional problem? If yes, please explain. *
Have you even been treated for: diabetes, heart disorder, or digestive problems? Any family history? If so, please explain. *
Are you being treated for any illness and under medical supervision? If so, please explain. *
Running Interests: *
Required
How long have you been running? *
Would you consider yourself a novice or experienced runner? *
How many miles per week have you averaged over the past three months? *
Have you ever done any speed workouts, tempo runs, hills repeats, interval training? *
Any recent or chronic injuries? Please list onset date *
Describe any problem with previous training cycle or racing. *
Most recent racing results. Please include the distance, date and personal best for each. *
List your weekly mileage for the past four weeks *
How many days a week do you run? List days of the week and preferred Long Run day. *
Do you have a targeted race to start training? *
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