Coaching Intake Questionnaire
Please complete this intake form to help Coach Karen understand your background, goals, and preferences.
Full name
*
First Name
Last Name
What is your age?
*
What is your address?
*
Telephone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Best way to contact you
*
Text
Email
Phone
Do you have any health issues?
*
Yes
No
If you answered "Yes" to the previous question, please describe
Would you be willing to have a physical exam prior to the start of your program?
*
Yes
No
How long have you been running / how did you get started?
*
Do you cross-train? If so, what & how frequently?
*
Do you want to continue to cross-train?
*
Yes
No
NA
What does a typical training week look like?
*
PR for 1 mile
*
NA if you do not have a timed 1-mile run
PR for 5K
*
NA if you do not have a timed 5K run
PR for 10K
*
NA if you do not have a timed 10K run
PR for 13.1 miles
*
NA if you do not have a timed 13.1 mile run
PR for 26.2 miles
*
NA if you do not have a timed 26.2 mile run
PR for other races
*
Short term goals
*
Medium term goals
*
Long term goals
*
Have you ever had a coach before? If so, how did that work out?
*
Enter any questions you have for Coach Karen?
Is there anything else Coach Karen should know about you?
Submit
Should be Empty: