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Runner Intake Form Data
- Email Address:
- First Name:
- Last Name:
- Phone Number:
- What is your limitation in training?
- If you have pain or discomfort, rate your pain while at rest:
- When does your pain begin?
- When did your symptoms begin?
- Can you describe when you first felt the injury?
- Has your training plan changed in the last 6 months?
- Please describe how your training has changed:
- Have you had any treatment to this area?
- Please describe all treatments to this area?:
- History of surgeries and injuries:
- Please discuss your health history:
- List all current medications:
- List any supplements you are taking:
- What is your typical caloric intake for a given day?
- What types of food are you eating?
- What is your current training regimen?
- What is your current competition season?
- What are your specific goals?
