Nutrition QuestionnaireAll information shared is confidential and will only be shared with our certified dietitian. Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Client Specs Age Height Weight Shirt size Gender Occupation Athletic Goal? Short Term/Long Term Nutrition Goal? Short Term/Long Term Do you have any medical concerns at this time? Any allergies or other nutrition concerns at this time? Do you take supplements/vitamins/etc? If so, what are you currently taking? How many hours of sleep do you get each night typically? How many minutes/hours do you spend training per day? Describe your normal nutrition Tell me what you eat for any given day (say yesterday) What are you consuming pre-workout if anything? What are you consuming during your workout if anything? What are you consuming post-workout if anything? How much fluid do you consume during the day? During your workouts? Do you consume caffeine? If so, how much per day and in what form? Are you stressed...are you always on the go at work or are you sedentary? Other nutrition/training information that would be good for me to know… Nutrition Program Which nutrition programs are you interested in? Nutrition Coaching Monthly Nutrition Plan Race Specific Fueling Nutrition Consultation Where did you hear about us? Friend/Family/Another Runner Ornery Mule Racing Website Ornery Mule Racing Social Media Ornery Mule Racing Event General Internet Search Google Search Other Thank you!
