Bike Fit Questionnaire


BY COMPLETING THIS QUESTIONNAIRE YOU CONFIRM THAT YOU PRESCRIBE TO THE FOLLOWING ETHICAL STATEMENT and acknowledgment of risk, release of liability, indemnification agreement and covenant not to sue

I believe cyclist should avoid the use of banned substances and I will abide by the purest rules and ethics of the sport of cycling set by USA Cycling, UCI, and the US Olympic Committee. I train, compete and participate “clean” and I know that success comes from preparation, tactics and hard work rather than something that comes in a pill or from a needle. In consideration of purchasing a bike fit from P. Dave Jordaan dba CyberCycleCoach (Releasees) I understand, agree and do not object to the fact that bike fit at times involves touching and adjustment of the body by the fitter and hereby freely agree for myself, my heirs, executors, administrators, legal representatives, assignees, and successors I HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNIFY AND NOT TO SUE the Releasees that are in any manner connected with bike fitting FROM ANY AND ALL RIGHTS AND CLAIMS INCLUDING CLAIMS ARISING FROM MY OR THE RELEASEES’ OWN NEGLIGENCE, which I have or which may hereafter accrue to me, and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation in or association with a bike fit including travel to or return from the bike fit.

  • Personal Information

  • Number of hours worked each week
  • small, medium, large
  • US & European if you know it
  • high arch, wide, etc.
  • Waking 3 day average for full 60-second count
  • Highest seen within the last 12 months
  • Athletic History

  • Describe all the excercise you currently do
  • Describe your Cycling Hydration, Energy Gel, Food Bar habits
  • Cycling Goals (be specific as possible)

  • This field is for validation purposes and should be left unchanged.