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Running Gait Analysis Programme — Runner Intake

🆔 1. Identification

Full Name *

Phone Number *

Email Address *

Preferred Assessment Date *

Preferred Time Slot *

🏃 2. Runner Profile

Age Group *

Years Running Regularly *

Target Race Distance *

📊 3. Training Load

Current Avg Weekly Mileage (km) *

Longest Single Run in Last 4 Weeks (km) *

Has your mileage jumped more than 10% in the last month? *

Yes No

🩹 4. Injury History

Do you currently have pain or discomfort while running? *

Yes No

Pain Location(s) — select all that apply

Foot/Ankle Achilles Calf Shin Knee IT Band/Outer Thigh Hamstring Hip Lower Back

Running Injury in Last 12 Months? *

Yes No

Injury Type(s) — select all that apply

Stress Fracture Tendinopathy Ligament Sprain Muscle Strain Plantar Fasciitis IT Band Syndrome Runner’s Knee (PFPS) Other

🚩 5. Red Flag Screening

Chest Pain, Dizziness or Fainting During Exercise? *

Yes No

Diagnosed Heart Condition? *

Yes No

Diabetes / Thyroid Disorder / Hypertension — select all that apply

Diabetes Thyroid Disorder Hypertension None

Diagnosed Bone Health Condition (Osteoporosis / Osteopenia)? *

Yes No

Recent Menstrual Cycle Changes (if applicable)

Yes No Not applicable

✔

🎉 Thank you — you’re registered!

Our team will reach out to confirm your assessment slot. Please arrive in running shoes and comfortable athletic wear.

JointsnMotion

From Pain to Power- Your Journey starts here. Expert Physiotherapist and fitness coaches guiding you from recovery to peak performance in clinic and Online. Experience Care that Moves with you

Shop 4, Vega, Hiranandani Estate, GB road, Thane, Maharashtra

(+91) 8575600040

(+91) 8006738000

jointsnmotion@gmaill.com

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🆔 1. Identification

🏃 2. Runner Profile

📊 3. Training Load

🩹 4. Injury History

🚩 5. Red Flag Screening

🎉 Thank you — you’re registered!

reboot

73-Year-Old Powerlifter Wins Silver at World Championship After Supraspinatus Tear