Step 1 of 3 - Personal Information 33% HiddenOrder Number HiddenQuery Type GIC DIY HiddenGait Imaging Center Personal InformationToday's Date MM slash DD slash YYYY Full Legal Name* Name you go by (if different from above) Email address* Phone number*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of birth* MM slash DD slash YYYY Gender* Male Female Occupation:*Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherJob TypeExecutiveManagementFull-TimePart-TimeTemporaryContractInternSeasonalHow did you hear about us?*Friend/ColleagueCompany/Coach/GroupEventWeb SearchSocial MediaYoutube/PodcastOtherName (if preferred): Which company, coach, or group? Which event? Which social media platform? Name of YouTube Channel or Podcast: If other, please explain: Exercise backgroundNumber of years running* Which activity do you engage in the most?*RunningTriathlonWalkingOther SportRunning5K10KHalf MarathonMarathonUltra MarathonTriathlonSprintOlympic70.3140.6Other SportSoccerBasketballCrossfitBootcampOtherRunning consistency* Consistently Inconsistently Preferred training* Endurance / Distance (>5K) Short runs (<5K) Speed work / track intervals Other Other preferred training Current races (this year)* 5k 10k 13.1 (Half Marathon) 26.2 (Full Marathon) 50k + Other Other current race Next "A" Race (name & location) "A" Race date MM slash DD slash YYYY Miles per week (current)* Longest run (current)* Current shoe model(s)*Include whether you "like" or "dislike" each shoe -- based on feel. Do you cross-train?* Yes No What kind of cross-training? And how often?*Do you strength-train?* Yes No What kind of strength-training? And how often?*Biggest running limiter(s)* History of InjuriesAny current pain?* Yes No If yes, where? (be specific)If yes, for how long?Mechanism of injury(if known) Has your injury been clinically diagnosed? Yes No If yes, by what kind of doctor(s) and what was/were the diagnosis/diagnoses?Please list your running goals*Would you like shoe recommendations?* Yes No NameThis field is for validation purposes and should be left unchanged.
