* 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
What club/s or team/s are you a member of ?
Would you like to receive the Hypercat Racing e-newsletter? (It includes product reviews, discounts, promotions, upcoming events & related news and information.) *
Yes No
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