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Athlete Intake Form

Maxime Rochet · Expert Coach in Road & Trail Running

Personal Information

First name

Last name

Date of birth

Phone

City / Region

Occupation

Runner Profile

Current level

Main discipline

Current weekly volume (km)

Training days per week

Main goal (race / distance / date)

Secondary goals

Best performances (distance, time, race name)

Health & Medical History

Do you have any current or chronic medical conditions?

None Cardiovascular Respiratory (asthma, etc.) Diabetes Hypertension Other

Please specify if needed

Are you taking any medications that may affect physical effort?

No Yes

If yes, which ones?

Have you had surgery or a serious injury in the past 2 years?

No Yes

If yes, please describe

Do you currently experience pain when running?

No Yes, mild Yes, moderate Yes, significant

If yes, location(s) and description

Injury History

Body areas previously injured (check all that apply)

Foot / toes Ankle Achilles tendon Calf Shin splints Knee Hip / ITB Lower back Upper body Other

Describe your significant injuries (type, frequency, treatment)

Equipment & Orthotics

Current running shoe brand / model

How long have you had them? (estimated km)

Do you wear orthotics?

No Yes, custom-made Yes, standard insoles

If yes, prescribed by whom? For what reason?

Do you use any other specific equipment (knee braces, ankle supports, taping, etc.)?

No Yes

If yes, please specify

Lifestyle & Recovery

Average sleep quality

Daily stress level

Do you practice other sports or physical activities?

No Yes

If yes, which ones and how often?

Do you have any dietary restrictions or follow a specific diet?

None Vegetarian Vegan Gluten-free Other

Expectations & Coaching

What motivated you to work with a coach?

Have you previously worked with a coach or physical trainer?

No Yes

Any additional information you would like to share

Consent & Confidentiality

The information collected in this form is strictly confidential and used solely for your coaching programme. It will not be shared with any third party without your explicit consent.

I have read and agree to the confidentiality terms above.

Signature

Date

Maxime Rochet · Expert Coach in Road & Trail Running · Nyon, Switzerland rochetmax@gmail.com · +41 78 237 12 54