Runner’s Questionnaire

Runner’s Questionnaire Instructions

In order for Coach Komen to plan your training regimen, he must first evaluate your running history, current level of fitness, and general health.  Please answer the questions on this form completely and as specifically as possible.  

The information gathered here will be used solely by Wilson Komen for creating your training plan.  He will not share your information with any other person or entity.  Your personal information is strictly confidential.  If you have any questions or concerns about completing this form, please contact Coach Komen.

Please note that the coaching provided by Wilson Komen of Coach Kiprunning is not intended in any way as a substitution for professional medical advice. If you have questions or concerns about your exercise regimen, personal nutrition, injury status, or your overall health, please contact your primary care physician for further assistance.

The Questionnaire

This field only requires a street address. Add any apartment number information in the optional "street address 2" field.
Please enter your apartment or unit number, if appropriate, here.
Please enter your complete phone number with area code and, as necessary, country code.
If you are an international trainee, Coach Komen might suggest that you communicate through Skype. Please enter your Skype name if you have an account.
If you are not local to Washington, DC, indicate your preferred method of communicating with Coach Komen.
This information will help Coach Wilson design an appropriate training plan.
Please offer Coach Komen as much detail as possible. What type(s) of injury? Were you treated? Are you currently injured? Have you been cleared to run? Describe any previous training or racing difficulties.
Rough averages acceptable
Rough averages acceptable
Rough averages acceptable
To the best extent possible, list name of race, date of race, distance, and your official time.
Discuss experience with past personal running coaches. If none, explain why you are seeking personal coaching. What are your general running goals?
You may list regular yoga, strength training, or other regular exercise regimens. If none, type "none."
Coach Komen will use this information to begin drafting your training plan.
Example: Monday-run; Tuesday-run; Wednesday-rest; etc.
Generally, long runs are scheduled during the weekend.
Generally, speedwork is scheduled for the middle of each week. These workouts will take, on average, one hour to ninety minutes.
If you are planning to run any races during your training, please list them here.
Feel free to add any additional comments about your training, racing, or medical history that you think will helpful to Coach Komen.