RUNNER QUESTIONNAIRE Name * First Name Last Name Phone * (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country AGE * Birthday * mm/dd/yyyy Sex * Male Female Height * Weight in lbs EMERGENCY CONTACT * NAME AND PHONE # (###) ### #### How did you hear about us? Option 1 Option 2 MEDICAL HISTORY DESCRIBE YOUR CURRENT GENERAL HEALTH AND ANY CURRENT ILLNESSES OR INJURIES. (EXCLUDING RUNNING INJURIES) * CHECK IF YOU HAVE EVER BEEN DIAGNOSED AS HAVING ANY OF THESE CONDITIONS If so, please detail below HEART PROBLEMS ANEMIA HIGH BLOOD PRESSURE STROKE OR TIA CONCUSSIONS ASTHMA DIABETES EATING DISORDERS HEPATITIS THYROID PROBLEMS CANCER ALLERGIES RHEUMATOID ARTHRITIS OSTEOARTHITIS DEPRESSION OTHER PLEASE EXPLAIN HERE WITH THE YEAR YOU WERE DIAGNOSED MEDICATIONS YOU CURRENTLY TAKE. (PLEASE INCLUDE OVER-THE-COUNTER MEDICATIONS TOO) DESCRIBE ANY RUNNING INJURIES, PAST OR PRESENT, AND HAVE THEY BEEN RESOLVED COMPLETELY? RUNNING EXPERIENCE/GOALS MY EXPERIENCE AS A RUNNER IS ... * I'M JUST GETTING INTERESTED IN RUNNING LESS THAN 6 MONTHS 6 MONTHS TO 1 YR 1-3 YEARS MORE THAN 3 YEARS MORE THAN 5 YEARS MORE THAN 10 YEARS WOULD YOU CONSIDER YOURSELF ... * BEGINNER RECREATIONAL AGE GROUPER / COMPETITIVE ELITE HAVE YOU DONE ANY RACES IN THE LAST YEAR? IF SO, WHICH ONES AND NOTE YOUR TIMES * WHAT ARE YOUR PERSONAL RECORDS (BEST TIMES) IN THE 1 MILE / 5K / 10K / HALF MARATHON / MARATHON HOW MANY MILES PER WEEK HAVE YOU AVERAGED OVER THE PAST 3 MONTHS? * * 0-10 10-20 20-30 30-40 40-50 50-60 60-70 >70 HOW MANY DAYS PER WEEK WOULD YOUR SCHEDULE ALLOW YOU TO RUN? * * 3 4 5 6 7 WHAT DAY OF THE WEEK DO YOU HAVE TIME TO DO YOUR LONGEST RUN? * SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY WHAT DAY OR DAYS OF THE WEEK WOULD YOU PREFER TO CROSSTRAIN OR TAKE OFF FROM RUNNING? * MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY DESCRIBE YOUR CURRENT RUNNING GOALS. WHAT DO YOU WANT TO ACCOMPLISH AND BY WHEN? * DO YOU HAVE A RACE OR RACES IN MIND? IF SO, WHAT IS/ARE THE NAME/DISTANCE/DATE OF THE RACE/RACES? * DO YOU OWN A GPS WATCH? (IE GARMIN, SUUNTO, APPLE, COROS) * YES NO IF SO, WHICH ONE? CHECK THE BOX IF YOU CURRENTLY HAVE AN ACCOUNT WITH.. * STRAVA (FREE VERSION) STRAVA PREMIER (PAID) GARMIN CONNECT ATHLINKS FACEBOOK INSTAGRAM NONE HAVE YOU SPOKEN TO ONE OF OUR COACHES ABOUT COACHING YOU? * YES NO IF SO, WHICH COACH CARY MORGAN ERICA SPEEGLE LAUREN HENDRIX WENDI CULVER BRITTANY HAYDEN ROB YOUNGREN CHAVET HILLS WHO REFERRED YOU TO CADENCE RUN COACHING OR HOW DID YOU HEAR ABOUT US? IF INVENTORY ALLOWS, WHICH WOULD YOU MOST LIKELY WEAR? * MEN'S TANK MEN'S SHORT SLEEVE WOMEN'S TANK WOMEN'S SHORT SLEEVE SIZE? * XSMALL SMALL MEDIUM LARGE XLARGE Thank you!
