Name: Stella Roy | User ID: 24 | Videos & Photos
Intake Form Data
| Phone | (123) 123-1231 |
| What is your limitation in training? (Specify complaints or problems) | asdf |
| If you have pain or discomfort, rate your pain while at rest. | 2 |
| When does your pain begin? | Before training |
| When did your symptoms begin? | Between 2-6 months |
| Can you describe when you first felt the injury? Tell us about what you were doing when you felt pain/a limitation in your training. | asdf |
| Has your training plan changed in the last 6 months? | Yes |
| Please describe how your training has changed. | fdsa |
| History of surgeries and injuries. Please include all. If none, type N/A. | fdasfdsa |
| Please discuss your health history. Include any chronic illnesses, such as asthma, diabetes, heart issues, etc. | asdfa567 |
| List all current medications (prescription and over the counter). | asdf123 |
| List any supplements you are taking. This includes all vitamins, shakes, infusions etc. Include the brand. | asdfasdf |
| What is your typical caloric intake for a given day? | Between 1000-2000 calories |
| What types of food are you eating? | Carbs (bread, pasta, etc) |
| What is your current training regimen? | asdf |
| What is your current competition season? | Spring |
| What are your specific goals? | Competition ready |