Coaching Questionnaire

Please take a few minutes to complete my new client questionnaire.  There may be questions you can’t answer, that is fine.  Answer what you can.  After I receive this form, I’ll e-mail you personally.  We will set some goals, I’ll develop an individualized training plan, and we’ll go from there.

Be assured that the information you provide will only be used to personalize your training plan and provide the best online coaching advice I can provide.   Please refer to my Privacy Policy if you have any questions or concerns.

Personal Information

Name*:
Email*:
Street Address:
City State Zip:
Cell Phone:
Can you receive text messages? Yes No

Physical Information

Birthday:
Age:
Sex:  Male Female
Height:
Weight:
Resting Heartrate:

Medical History

Have you ever been diagnosed with any of the following conditions:
 Cancer Heart Problems High Blood Pressure Asthma Stroke Anemia
 Thyroid Problems Diabetes Allergies Arthritis Eating Disorder Depression
 

 
Medications:
(Please list any current medications you currently take, including over-the-counter medications)
 

 
Are there any other medical conditions that I need to be aware of?

Running Injuries

Currently Injured  Yes No
Date of Injury
Current treatment
Previous Injuries (Include dates)

Running Background

Select your previous racing experience
How long have you been running?
Any previous exercise or competitive history?
Please list the distance and time results of any race from the last 6 months.
List your best race performances. (Include distance, time, date, and name of race)
Running interests
 Fitness or Fun Recreational or social racing Racing for improved performance Racing for age group or other awards
   
List your running and racing goals. 

(Include future dates, distances, time goals, etc.)
Describe any previous problems you’ve had with racing or training.
Do you perform any other sorts of exercise? 

(Cross-training, Flexibility exercises, Strength training  Etc.) 
Describe your last 4-6 weeks of training. 

Include miles or time spent running, your pace, the surface or terrain (track, hills, trails, treadmill)

and any supplemental training (weights, yoga, cycling, swimming, etc.)

Training Information

How many days a week you are willing to train?
Which days of the week do you prefer to train?
Which days do you prefer for your long runs? (usually Saturday or Sunday)
Any training races you plan to do?

(this may include smaller races along the way that aren’t necessarily your “key” race)
Any scheduling conflicts/limitations?

(vacations, previous commitments, work schedule, etc.)

Training Equipment

What equipment do you have available to you?

(Home Treadmill, Gym Treadmill, Outside only, etc)
What shoes do you currently have for running? 

List manufacturer, model, and age.

Coaching History

Do you have any prior experience with Team or Individual Coaching? 

If yes, please describe positive or negative aspects of that experience.
What are your expectations from personal online coaching?
Any additional comments or concerns?

1-on-1 Coaching from Lesley - $75/month

Customized bi-weekly training schedules based on your goals, fitness level, limitations and personal schedule. Includes unlimited communication via email and text along with race preparation and analysis.

RRCA Certified Coach- $75 per month.