Run and Strength Coaching Intake Form

Please fill out the following form.

First name

Last name

Date of birth

Month

Day

Year

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness or injury?

Yes

If you answered yes to any of the questions above, please supply additional information.

Are you currently working with any other healthcare or wellness providers that you would like me to collaborate with (e.g., physician, physical therapist, dietitian, therapist)? If yes, please provide their information below:

What is your everyday life like (work/kids/school/other hobbies/commitments)?

What are your goals related to running and strength training?

Is there a recurring day and time you would like to schedule for a monthly video or phone call? If you don’t want every month please indicate a frequency that would work for you (you can change this anytime in the future).

Broadly, what is your general athletic history?

Tell me specifically about your running history. How did you find the sport, how long have you done it, etc.

Tell me specifically about your strength training history. Are you using strength to complement an existing sport or hobby? How did you find the sport, how long have you done it, etc.

What does your typical training week look like? What would you like it to look like?

How many days per week do you want to train? How many days per week do you want for rest? How many days per week are you doing something else?

Which day of the week is best for your long run? If you work a typical M-F schedule, is Saturday or Sunday best for you?

Any other scheduling notes (i.e. do you travel often, does your schedule change season to season)?

How competitive would you describe yourself as?

What are your weaknesses as an athlete (specific technique, areas where you're weaker, etc)?

What are your strengths as a athlete (movements you do best, areas of training that you like and/or excel in)?

Describe some things that went well and failure points from previous training or racing.

Have you worked with a coach before? If so, what did you enjoy and what did you wish was different?

Have you ever done strength training?

What type of gym equipment do you have access to? A full gym, free weights, etc?

What other types of activities do you do (cycling, swimming, yoga, etc.)?

Do you have experience doing “speed work” and how do you feel about it?

Tell me about any past or current injuries.

Do you have any medical concerns or conditions I should know about?

Are you on any medications currently that I should be aware of?

Do you adhere to a specific diet (vegan, gluten free, etc.)?

If applicable, do you feel your menstrual cycle impacts your training?

If applicable, do you track your cycle?

What are your short-term goals?

What are your long-term goals?

Do you have any personal goals such as a better diet, sleep, stress, etc.?

Do you have any body composition or longevity related goals?

Are you currently signed up for any races?

Is there anything else I should know about you?

Initials

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