The Bike Shop

Fit Questionnaire
Name___________________________ Age_______ Gender M F

Address_____________________ City_____________ Zip_______State___

Phone __________________________ Email_____________________

Years of serious cycling _____ Hours of weekly cycling (current)______

Have you been fit before? Y N

When are your ‘A’ races this year: ____________________________________

________________________________________________________________

Past or current joint or overuse injuries? Y N Which?

_______________________________________________________________________
_

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Are you currently seeing a Chiropractor/Physical Therapist?_______

If so why?______________________________________________________________

Cycling goals ___________________________________________________________

Please rate your current fit:

1. Super comfortable and very fast

2. I’m comfortable, but not very fast
3. I’m uncomfortable, but very fast
4. I’m uncomfortable, and slow

What would be your ideal bike fit?

1. Super comfortable and very fast

2. Comfortable, but not very fast
3. Uncomfortable, but very fast
4. Uncomfortable, and slow