Name First Last Email PhoneWhat is your limitation in training? (Specify complaints or problems)* If you have pain or discomfort, rate your pain while at rest.*0 - no pain12345 - moderate pain678910 - excruciating painWhen does your pain begin?* Before training During training After training All of the above When did your symptoms begin?*Within the last monthBetween 2-6 monthsLonger than 6 monthsCan you describe when you first felt the injury? Tell us about what you were doing when you felt pain/a limitation in your training.Has your training plan changed in the last 6 months?* Yes No Please describe how your training has changed. Have you had any treatment to this area?* Yes No Please describe all treatments to this area.History of surgeries and injuries. Please include all. If none, type N/A.*Please discuss your health history. Include any chronic illnesses, such as asthma, diabetes, heart issues, etc.*List all current medications (prescription and over the counter).*List any supplements you are taking. This includes all vitamins, shakes, infusions etc. Include the brand.*What is your typical caloric intake for a given day?* Under 1000 calories Between 1000-2000 calories More than 2000 calories What types of food are you eating?* Meats (red) Lean meats (chicken/fish) Carbs (bread, pasta, etc) Vegetables and fruit Protein bars and shakes Snack foods (such as chips, candy, etc) What is your current training regimen? Discuss number of days per week, miles per day, treadmill or outdoor (terrain, hills, flat, track, road, trail), cross training regimen and days per week, specific sets/reps, types of exercise.*What is your current competition season? Pre-season In-season Post-season All Year What are your specific goals?* Pain free running Marathon or distance race Competition ready Evaluation Fee Price: Total $0.00
