Peninsula BIke Fit, Pre-Fit Questionnaire

Peninsula Bike Fit, Pre-Fit Questionnaire

Welcome! Please take your time to answer these questions as fully and as honestly as possible. Your answers are essential to help prepare and understand you as a rider, your fit needs and goals, and to ensure you receive the most accurate fitting solution available. Even the smallest, seemingly insignificant detail can be important. We look forward to working with you.
Personal Details
Please upload a picture of your bike / bikes (NOT a manufacturers image) - if you don't have a bike yet, upload any picture to complete the form

Cancelof
Full Name*

TitleFirst NameLast Name
Date of Birth*

MonthDayYear
Gender*
Height (mm)*
Weight (kg)*
Inside Leg (mm)*
Home address*

Street Address

Street Address Line 2

CityBorough

Post Code
Phone Number*
E-mail*
example@example.com
Occupation*
Goals
Which fit service would you like?*
If 'Other', please specify your service requirements
Your short-term (within next 6 months) riding goals*
Your long-term (within 2 - 5 years) riding goals*
What is the main reason for this fit?*
What is your ideal outcome for the fit?*
Cycling Discomfort
Have you or do you currently suffer from any of the following whilst riding? (check all that apply)*

Numb handsNumb feetHotspots under footSaddle sorenessKnee painBack painNeck acheNone
Please elaborate further about the cycling related injuries or illnesses you have had in the past or are currently suffering from
Bike Fit History
Have you had a bike fit before?*

YesNo
If yes, please email a copy of your latest bike fit to: info@peninsulabikefit.com.au or list the details in the text box
Did the last bike fit you had meet your aims and expectations? If not, why not?
Your Riding
How long have you been cycling for?*
What is the make and model of your current bike ?*
What size is your current bike?*
How long have you had this bike?*
Describe the type of riding you currently do on this bike - e.g. recreational, racing, sportive riding, triathlons, mountain biking.*
Approx how many times per week do you ride?*
On average, how long are you out and what distances do you cover on your regular rides?*
Rate how regularly & consistently you ride on a weekly basis*

1

2

3

4

5

1 is Sporadic, 5 is Every week
What other forms of exercise do you regularly undertake?*
What size shoe do you wear*
Do you currently wear cycling shoes with cleats?*

YesNo
If yes, please specify which brand of shoe
Which pedal system and cleats do you use
Your Health & Well Being
How would you describe your current health and well being?*
How would you describe your current stress levels both physically and mentally?*
Do you consider yourself to have a disability? If yes, please elaborate*
Have you ever had any other serious injury or operations? If yes, please elaborate*
Have you ever had any of the following conditions:*

Covid 19Heart trouble, stroke or AnginaHigh blood pressureEpilepsySudden breathing difficultiesOrthopaedic, arthritic, other bone or joint conditionsNone of the above
Are you:*

PregnantOn medicationA smokerNone of the above
Consent To Practice
I understand that bike fitting may require some strenuous activity and there may be some risks associated with this. I declare that I am in good physical and mental heath to undertake such activity. I have not been advised by a medical professional to exclude myself from such activity.*

I agreeI do not agree
I understand that I have the right to ask about these risks and have any questions answered prior to the fitting. I know it is up to me to inform the bike fitter about any reason why participating in a bike fit may be result in a serious risk to my health.*

I agreeI do not agree
I consent to and authorise Peninsula Bike Fit to carry out a bike fit with me. Further, I exempt Peninsula Bike Fit from any liability for personal injury or property damage occurring from any cause during a bike fit.*

I agreeI do not agree
I understand that Peninsula Bike Fit will collect and store my personal information for the purposes of bike fitting. I will have access to this information. My personal information will not be shared with any other parties without prior consent.*

I agreeI do not agree
Occasionally we may share images and videos captured during a bike fit on social media as a way of illustrating bike fit methodology, successes and culture. Tick 'I agree' if you don't mind us using images and videos from you session in this way. There is no obligation to consent.*

I agreeI do not agree
We occasionally send out a newsletter to our riders with news, events, musings and exclusive offers. Tick 'I agree' to sign up and be the first to know.*

I agreeI do not agree
I certify that all the information I have provided above is truthful and correct to the best of my knowledge.*

I agreeI do not agree
And Finally...
What's the most rewarding ride you've done?*
Should be Empty:

Peninsula Bike Fit, Pre-Fit Questionnaire

Personal Details

Goals

Cycling Discomfort

Bike Fit History

Your Riding

Your Health & Well Being

Consent To Practice

And Finally...