Personal Details Questionnaire

Personal Record Name: Address: Date of Birth: Height: Weight: Do you smoke: Yes No Estimated average alcohol consumption per week: Home phone number: Work phone number: Mobile phone: Email: RUNNING DETAILS How many months / years have you been running? Have you followed a structured programme before? Yes No If so, for how long? What results did it bring and what were your feelings about it? Please describe an average week’s running (any time in the last three months). Please list the different surfaces you run on and what percentage time on each. Road: Grass/trail: Running Track: Treadmill: Other: PRESENT TRAINING DETAILS How many miles a week are you running? How much time do you currently spend running? How much time do you currently spend cross-training (aerobic activities, such as cycling, swimming or on the cross trainer, or weight training)? Please give an example of what you do over a typical week. How much time do you currently spend on Resistance / Weight Training? Please give an example of your programme over a typical week. How much training time overall do you wish to commit to? Name one short-term goal (say, three months) and one medium-term goal that you want to achieve. short-term: medium-term: ALTERNATIVE SPORTS DETAILS Which other sports are you actively involved with? How much time do you currently spend on it / them weekly? Which sports do you follow as a spectator? How much time do you currently spend on it / them weekly? OCCUPATION DETAILS: How do you earn a living? Employed / self-employed? How much flexibility in terms of working hours do you have? How much flexibility in terms of time to train does this give you? How do you commute? Is it feasible to either run or cycle to work sometimes (say, in the spring/summer)? FAMILY DETAILS / RESPONSIBILITIES Please describe these: HEALTH DETAILS CURRENT AILMENTS OR INJURIES: (Please list each one; when it started; what treatment you’re having and from where; how it affects you daily and your running) CURRENT MEDICINES / DRUGS TAKEN: HAVE YOU VISITED A DOCTOR OR HOSPITAL IN THE LAST FIVE YEARS? Yes No IF YES, WHEN, WHERE, WHAT FOR, TREATMENT GIVEN AND ANY REACTION TODAY? HAS ANY OF YOUR CLOSE FAMILY DIED EARLY OR SUFFERED A CRITICAL ILLNESS OR CONDITION (e.g., heart attack, stroke, cancer, diabetes, etc.)? PLEASE GIVE DETAILS (including their age and dates): FEMALES: DO YOUR PERIODS AFFECT YOUR RUNNING? Yes No IF YES, GIVE DETAILS (including time of month) AND HOW YOU DEAL WITH IT: ANY OTHER ASPECTS OF YOUR HEALTH THAT I SHOULD KNOW ABOUT (e.g., allergies, eating, sleep, etc.)? DO YOU HAVE ANY EATING REQUIREMENTS OR ALLERGIES? Terms and Conditions My Responsibilities to You: To provide you with a monthly, developmental, training programme, appropriate to your level of fitness and ability. To receive your Training Diary weekly and respond with comments and recommendations according to the Programme you are on.  That is, by e-mail, by telephone conversation or by a face-to-face meeting. To reply to e-mails promptly (or to notify you when I’m not going to be available). To offer you access to wider training components to enhance your chances of successfully attaining your goals. To guide you through injuries by more regular communication and advice. Your Responsibilities to Me: To avoid placing your health at risk by not training when unwell. To keep me informed when suffering ill health. To agree to follow my recommendations when ill or injured, as I will be more objective than you. To send me a full, detailed Training Diary on a weekly basis, including feedback comments on how you are reacting to the individual training sessions. (Only by doing so may I assess the effect the training is having on you and I can then tailor the next programme more directly to your needs and responses.) To take a sensible approach to training, such that you don’t persist with training when you have a niggle or sore throat, on the basis that it’s preferable to miss one or two days rather than one or two weeks. (Unfortunately, all runners with some years’ experience without a coach have ended up suffering the latter, me included!)

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