Personal Training Plan – your evaluation

Personal Information

Please add your personal details below. This will help us suggest the best solution for you. All information will stored securely and will never be shared with any third party.

Are you currently injured or carrying a painful niggle?*

Yes
No (then this is the wrong questionaire - please go to our competitive or beginner section)

*

Physical Activity Readiness questions*

We use this to insure we can treat you without putting you at further risk

I was diagnosed with a heart condition
My doctor informed me I should only do exercise prescribed by a doctor
You have experienced chest pain during exercise
You have lost balance due to dizziness and/or suffered unconsciousness
You have a bone or joint problem that could be made worse with physical activity
Your doctor is currently prescribing you drugs for a heart condition
You are currently taking some kind of prescription drug
tick if you know of any other reason you should not be doing physical activity
None apply, I am in normal condition

Your injury details and history

Tell us about your target race, sport and discipline and how you generally train. Title and description here should probably change.

When would you prefer to start your rehabilitation?*

Details of your current injury and/or niggles*

In a perfect world when would you like to be ready to race again?*

1 to 6 weeks for very minor injuries, 12 weeks for consistent niggles and 3-6 months for major and very long-term injuries)

Once your injury is gone what is your main priority with running?*

Please list every injury you have had (i.e. knee pain, broken left arm etc.)*

Have you previously had running technique or biomechanical analysis done?*

Are you currently able to run pain-free despite the injury?*

Yes, no pain before, during or after
Yes, no pain during but some after or before
No, always in pain when attempting to run
No, I am in pain both when running, walking and in general

For a potential personal consult what clinic would suit you prefer to be seen in?*

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Personal Training Plan – your evaluation

Personal Information

Your injury details and history

CE Staff

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