Barbell Medicine Questionnaire
Initial Client Information
Email Address *
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Name *
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*
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1. Age *
Your answer
2. Height *
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3. Weight, indicate lb or kg *
Your answer
4. Bodyfat % (use Navy BF test if unknown available here-http://fitness.bizcalcs.com/Calculator.asp?Calc=Body-Fat-Navy) *
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5. Overall Goal(s) Be as specific as possible. *
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6. Upcoming meet or competition *
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7. Current protein/carbohydrate/fat intake (in grams)and calories (track for 3 days and provide averages if unknown using MyFitnessPal or similar): *
Your answer
8. Current Training (include conditioning/weights/sport/etc.) Please explain your current training week. *
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Current Lifts ( if you are currently training please provide your recent squat, bench, press, and deadlift numbers)
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9. Current supplements/vitamins (if any): *
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10. List any food allergies, supplement allergies, diseases, or disorders: *
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11. How many times per week do you train and on what days? How many times are optimal? *
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12. What kind of equipment do you have access to for training (prowler/rower/sled/bands/chains/boards/specialty bars, etc.) *
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13. What does your work schedule look like and how hard is it to eat while working? *
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14. Any injuries (current or previous)? If so, what movements can you not do? *
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15. Please include any other pertinent info that you think our coaches need to know and we’ll start laying out a plan to hit your goals! *
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