Name: | User ID: | Videos & Photos
Intake Form Data
| Phone | |
| What is your limitation in training? (Specify complaints or problems) | |
| If you have pain or discomfort, rate your pain while at rest. | |
| When does your pain begin? | |
| When did your symptoms begin? | |
| 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. | |
| Has your training plan changed in the last 6 months? | |
| Please describe how your training has changed. | |
| 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? | |
| What types of food are you eating? | |
| What is your current training regimen? | |
| What is your current competition season? | |
| What are your specific goals? |