Client Questionnaire

Back to Anaerobic Management

Please fill it out as completely as possible and hit the submit button at the bottom of the page. You're under no obligation by submitting the questionnaire. Your information only saves time in evaluating your needs and in beginning your program. We'll get back to you as soon as possible by email or phone. We look forward to hearing from you.

First Name:  Last Name: 

Street Address: 

City: State: 
Zip: 

Country: 

Email: 

Phone: 

Occupation:  Marital Status:  Children:

Height:  Weight: Age: Gender:

What are your reasons for seeking personal coaching?

How did you find out about Anaerobic Management?

Running History

How many years have you been running: Age when you started:

Your competitive history, list your personal bests:

High School, events and times:

College, events and times:

Post Collegiate, events and times:

Masters, events and times:

Competitive times you've done in the last 12 months:

5k 8k 10k 15k 10m 1/2 Mar Mar

Other:

Describe in detail your last 4 weeks of training:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Week One              
Week Two              
Week Three              
Week Four              












Breifly describe your last 12 months of training:

Health History

Describe any injury problems and when they last occured:

Do you have any health problems or family history of health problems which might affect or limit you training
(ie. heart disease, diabetes, hormonal problems, thyroid, high blood pressure...)?

Are you currently using medications? If so, what are they and how do they affect your running?

Briefly, how would you describe your diet?

Goals

What are your short term goals? (next 6 months)

What are your long term goals?

List any specific races and their dates you want to do in the next two months:

Miscellaneous

Are there any problems you have with racing and training that we might need to know about?

Do you own a heart rate monitor?

Do you cross train? How often?

What sports do you use for cross training and why?

What kind of training do you like the most and what kind do you like the least?

For each day: how much time do you have to train and when? Which days are easiest for training and which days are
hardest (ie. long work day)? Indicate days where you have traditionally done long runs or hard workouts.

Mon

Tue

Wed

Thu

Fri

Sat

Sun

 

Do you train with a group or traininig partner? On what days? For what kind of training and how often?

Training Environment

Do you have access to: (please describe)

a 400m track

trails or dirt roads

large grass area

pool hilly running course

treadmill

Please print a copy of your questionnaire BEFORE sending it to Anaerobic Managment. We are currently experiencing server problems and want to insure the delivery of your information. In the event that your questionnaire is not received, your printed copy can always be sent by fax or mail. We apologize for any inconvenience.

By sending this information sheet you agree to the following wavier and liability release

I hearby attest that I am in good health and capable of participating in a vigorous training program for the purpose of improving my fitness. I understand the risks of participating in any physical activity and the risks associated with running programs in particular. I have consulted a liscensed medical doctor to verify my ability to engage in a high level running conditioning program. I have read, voluntarily signed this release and hereby for myself, my heirs executors and assigns, waive, release and hold harmless Jon Sinclair, Kent Oglesby and Anaerobic Management from any and all claims, demands, liabilities, rights or causes of action arising out of or in connection with participation in activities proscribed by the aforementioned parties

Back to Anaerobic Management