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Birthday

Athlete History

Are you currently an active athlete (Runner, Triathlete, Duathlete, other)

Health History and Activity Readiness

Please explain any "Yes" answers in the space below.

Has a doctor ever said that you have a heart condition and recommended only medically supervised physical activity?
Do you have chest pain brought on by physical activity?
Have you developed chest pain within the last month?
Do you tend to lose consciousness or fall over as a result of dizziness?
Do you have a bone or joint problem that could be aggravated by the proposed physical activity?
Has a doctor ever recommended medication for high blood pressure or a heart condition?
Are you aware, through your own experience or a doctor’s advice, of any other physical reasons against your exercising without medical supervision?
Do you have any metabolic diseases, controlled or uncontrolled, such as diabetes, hyperthyroidism, hypothyroidism, etc.?
Do you, or have you ever, smoked regularly?
Do you take any drugs or medications?
Are you, or have you been, recently pregnant?
Do you have high cholesterol?
Have you had any surgery in the past year?
Have you ever had an injury that caused you to stop exercising for more than one week?
Are you, or have you ever been, anorexic or bulimic?
Are there any other physical or emotional problems that may affect your training?

Past and Current Medical History

Do you have, or have you had, any of the following?

Heart Disease
Heart Attack
Heart Surgery
Heart Murmur
Hypertension
Thyroid Problems
Asthma
Wheezing
Diabetes
Epilepsy
Anemia
Stress Fracture
If female, is there a chance you could be pregnant?

Goals

Equipment and other information

Do you own a Heart Rate Monitor?
Do you own a smart watch (Garmin, Apple, etc.)?
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