LOLA Health Questionnaire

LOLA Runners Health Questionnaire
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name
Age
Email
example@example.com
Current fitness level
Miles per week average over the past 2 months
Longest run in the past 2 months
What are your training goals?
Please include any recent illness, injury or surgery
Are you currently receiving treatment for your injury?
If yes, what type of treatment?
Current medications: (if any)
This information will be kept confidential and used only to make recommendations for your training program
Should be Empty: