* Required fields
Name *
E-mail Address *
Age? *
Gender? *
Male
Female
I am seeking a fit for? *
Pre-purchase
New bike
Existing bike
Custom bike
Type of bike being fit? *
Road
Triathlon
Time Trial
Mountain
Track/ Fixed
Cyclocross
Other
Follow-up
Cleat/ Shoes
Bicycle Brand, Model, Year
Do you use clipless pedals? *
Yes
No
Which brand of pedal do you use? *
Look/ Keo
Speedplay(road)
Speedplay(mtn)
Shimano(road)
Shimano(mtn)
Time
Crank Brothers
Ritchey
Other
Flat/ Toeclips
Please list shoe information: Brand, Model, Size; if known
Do you use currently use cleat shims, wedges, specialty insoles or orthotics? *
Yes
No
In response to the previous question, please explain what you currently use and why.
RIGHT FOOT - Do you currently experience any of the following? Check all that apply.
Toe numbness
Pain
Tingling
Hot Foot
Arch pain
LEFT FOOT - Do you currently experience any of the following? Check all that apply.
Toe numbness
Pain
Tingling
Hot Foot
Arch pain
RIGHT KNEE - Do you currently experience pain in any of the following areas? Check all that apply.
Front
Rear
Outside
Inside
Above
Below
LEFT KNEE - Do you currently experience pain in any of the following areas? Check all that apply.
Front
Rear
Outside
Inside
Above
Below
BACK - Do you currently experience pain in any of the following areas? Check all that apply.
Lower Right
Lower Left
Mid
Upper
SADDLE - Do you currently experience any of the following? Check all that apply.
Pain, front of saddle
Pressure, front of saddle
Numbness, front of saddle
Pain, under sits bones
Chafing
Difficulty staying in one position
Feeling of sliding forward or backward
HANDS - Do you currently experience any of the following? Check all that apply.
Numbness, Right hand or palm
Pressure/ Pain, Right hand or palm
Tingling in Fingers, Right Hand
Numbness, Left hand or palm
Pressure/ Pain, Left hand or palm
Tingling in Fingers, Left Hand
Difficulty reaching brake/ shift lever
OTHER ISSUES - Do you currently experience any of the following? Check all that apply.
Headaches, during or shortly after rides
Hamstring pain, either leg.
Calf Pain, either leg.
Ankle/ Achilles pain, either leg.
Hip pain, either side.
Additional Physical Issues: Please list and explain any addiitional issues you are experiencing, including previous injuries &/or relevant surgeries.
Have you ever been through a professional bike fitting session before? *
Yes
No
When was your last professional bike fit? *
Never
Under 1 year
1-2 years
More than 2 years
Approximately how many hours a week do you train on the bike?
0-1
1-5
5-7
7-10
10+
I live on my bike
How did you hear about Hypercat Bike Fit Services? *
Web Search
Referral
Previous Client
Hypercat Coach
Advertisement/ Flyer
Gift Certificate
Clinic/ Race Expo
Social Media
Bike Shop/ Club
Tri Shop/ Club
Chiropractor/ Medical Professional
Other
Hypercat Racing is a referral business and we wish to recognize those that sent you to us. Please provide us their name and business so we can thank them.
What club/s or team/s are you a member of ?