Name *
Name
Email Address *
Mobile Number *
Address *
What age range do you compete in
U20 years
20-25 years
25-30 years
30-35 years
35-40 years
40-45 years
45-50 years
50-55 years
55-60 years
60-65 years
65-70 years
70-75 years
Length of longest run in the last month
Haven't been running
15-30 mins
30 - 60 mins
1-1.5 hrs
1.5-2 hrs
2+ hrs
How many times per week do you run
0
1
2
3
4
5+
What type of running are you doing presently
Easy endurance running
No running
Mixture of interval (reps) & endurance running
Length of the longest bike ride in the last month
Less than an hour
1-2 hrs
2-3 hrs
3+ hrs
How many times do you bike outside per week
0
1
2
3
4+
How many times do you bike indoors per week (spin or windtrainer)
0
1
2
3
Have you swam in the last month
Yes
No
How far did you swim in the longest session in the last month
Less than 1000 m
1000 - 1500 m
1500 - 2000 m
2000 - 2500 m
2500 - 3000 m
3000 - 4000 m
4000 m+
Do you swim in a squad presently
Yes
No
If you are in a squad please note down the days you swim & the name of your coach
Note down best times for any distance from 100 m to an Ironman swim event
Do you have any re-occurring injuries or injuries at present
Please list and give a short description of the issue, and who is treating it
Is this an area you need assistance in
Swim Technique
1
2
3
4
5
6
7
8
9
10
Open Water Swim Skills
1
2
3
4
5
6
7
8
9
10
Swim Speed at the start line
1
2
3
4
5
6
7
8
9
10
Swim Speed over 400 m
1
2
3
4
5
6
7
8
9
10
Swim Speed over 1500 m
1
2
3
4
5
6
7
8
9
10
Present ability to complete a bike event of your key event distance up to race day expectations
1
2
3
4
5
6
7
8
9
10
Bike hill climbing ability
1
2
3
4
5
6
7
8
9
10
Bike flat power/strength ability
1
2
3
4
5
6
7
8
9
10
Ability presently to run your key event distance at race pace
1
2
3
4
5
6
7
8
9
10
Transition speed from swim to bike legs
1
2
3
4
5
6
7
8
9
10
Transition speed from bike to run legs
1
2
3
4
5
6
7
8
9
10
