Clone of Roeder Multisport Athlete Background Information Questionnaire

Middle School & High School Runner Questionnaire

Please fill in as much detail as possible.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Grade *
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
General Medical History
Significant Medical History (surgery, injuries, serious illness):
Anything that could impact training
Please list any current illness, recent injuries, recent surgeries, or past medical problems or surgery of note. (asthma, seizures, headaches):
Height:
Weight:
1. Please list the sports and activities in which you have participated most often throughout the past couple of years. Include duration participated, how long ago, how competitive your were, and any other comments.
2. List your best (or favorite) race results, events, times, place, conditions, and so on.
3. On average, how many miles per week did you train in the last month? *
3. On average, how many miles per week did you train in the last year? *
4. Do you have any chronic injuries from any sport or activity that may flare up or should be taken into consideration in developing your training plan?
5. What do you feel are your strengths and weakness as an endurance athlete?
Current Fitness Level Information
What is your resting heart rate?
1. What’s the highest heart rate you’ve had while Running?
Describe your current training week. If you keep a training log include a copy of your last week. Be as specific as possible with distance, paces, etc.*
Is this more, less, or the same as a normal training week for you?
What is your typical long run (distance and pace)?: *
What are your two favorite workouts?:
Do you currently strength train? If so, how often a week. What does it entail?
Are you currently recovering from any injury or illness? Explain:
RACING AND PERFORMANCE GOALS
List below all the events you plan on possibly competing in this year. We understand this schedule is subject to change. *
HIGH PRIORITY EVENTS (A RACES): These are the most important events of the racing season to you. There should be only a few of these because we will design your training schedule to taper and peak for them.*
Date Event Distance(s) Goal Time / Place
In a year's time what athletic related goals are you looking to achieve?*
EQUIPMENT AND OTHER INFORMATION
Do you own a smart watch (Garmin, apple, etc.) to track workouts?
What is the make and model
PoolTreadmillTrack (outdoor)Track (indoor)BikeStationary bikeElliptical or Arc MachineWeight Room
Smart WatchHeart Rate Monitor (Run)New running shoes (daily trainers)New racing shoes (super shoes or spikes)
Coaching Preferences
Have you worked with a running coach before? If so, what did you like about it and what would you change. You do not need to share coach or club names, just overview.
Individual Training PlanInjury Prevention TipsRace Plan and StrategyStrength Training PlanWeekly Check-in from Coach through training plan platformText and email communicationPhone CallFaceTime/Zoom Call (Monthly)Pre-Race Call with CoachIn-Person Individual Training SessionsIn-Person Group Training SessionsCoach present at "peak" eventsOther
What are your most important priorities when looking for a coach?
Anything else you would like to share that would be helpful for coach to know to help you in your process?
How did you hear about us?
Should be Empty:

Middle School & High School Runner Questionnaire

General Medical History

Current Fitness Level Information

RACING AND PERFORMANCE GOALS

EQUIPMENT AND OTHER INFORMATION

Coaching Preferences