Energy Fuel - Athlete Intake
Name *
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email address *
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Best phone number to be reached on *
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Date of birth *
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Current weight (approx) *
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Height *
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Current racing schedule (if applicable)
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Number of hours physically active (in training) on ave per week (currently) *
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Have you worked with a nutrition professional before
Comments (if applicable)
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Expectations of the program
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Do you consider your daily hydration to be: *
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Do you consider your daily nutrition to be *
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Do you consider your weekly physical activity to be *
please explain:
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List goals for nutrition out comes *
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If other, please explain:
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any major food issues/allergies
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Medications
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Supplements
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Alcohol intake (on average per week)
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What obstacles do you face when working on daily nutrition
Please explain:
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how do you rate your overall sleep (1 poor; 5 excellent)
how many hours on average do you get of sleep per night
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any other major issues you face nutritionally
if included other, please explain:
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anything else you feel you may need your nutritionist to know:
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