LOLA Health Questionnaire

LOLA Runners Health Questionnaire
Date

MonthDayYear
Date
Full Name
Age
Email
example@example.com
Current fitness level

ExcellentGoodFairNeeds Improvement
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?

YesNo
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: