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Ultra-Marathon on a Total Knee Replacement
Application
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Indicates required field
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Email
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Do you use social media? Select all that apply.
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Facebook
Twitter
Instagram
User name for each social media site.
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What is the best way to reach you?
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Do you have a Training Peaks account?
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Yes
No
If yes, what email is associated with it?
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Date of Birth mm/dd/yyyy
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Age
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Height
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Weight
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Medical Information
Do you have any medical issue we need to be aware of?
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Yes
No
If yes, please explain
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Have you had any injuries in the last year?
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Yes
No
If yes, please explain
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Has a doctor advised you not to participate in physical activity?
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Yes
No
If yes, please explain
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Do you take over the counter or prescription drugs?
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Yes
No
If yes, please explain
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Do you regularly exercise? (3 days per week or more)
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Yes
No
Do you ever feel light-headed while exercising?
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Yes
No
Do you have high blood pressure?
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Yes
No
Do you have high cholesterol?
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Yes
No
Are there any other health concerns or injuries not mentioned?
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Yes
No
If yes, please explain
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Focus
What is your sport focus? (list all that apply)
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What size pool do you have access to? (check all that apply)
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25 yard
25 meters
50 meters
Other
Do you have access to a safe, open water swim environment?
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Yes
No
Do you have an indoor bike trainer?
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Yes
No
If yes, what type? (i.e. smart, magnetic, fluid, etc)
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Do you have a heart rate monitor?
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Yes
No
If yes, is your heart rate monitor GPS enabled?
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Yes
No
Training
In the following section please indicate what training you can do each day of the week and at what time of the day. Please be as specific as possible with details. This is flexible if you want to change your schedule later due to work or family schedules.
Example: Monday - Swim in the AM, run or bike in the PM. Wednesday - Swim in the AM only, no PM workouts. Saturday - Swim, bike or run anytime. Sunday - Must have the day off.
Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Saturday
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Sunday
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Goals
Please indicate your top one or two races for the up coming season.
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What would you say is your weakest area, or the area that needs to most improvement and why?
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Why do you want to hire a coach?
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When would you like to get started training?
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Please review your application to ensure you have answered all questions as accurately as possible. Once you are ready, please Submit this form and I will follow up with you as soon as possible. Thank you!
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