What is your name?
What is your email?
What is your phone number?
What is the single biggest health or personal challenge you are facing right now? [ please be specific and as detailed as you would like] "I am working out but not truly achieving my goals" "I frequently feel exhausted." " I know what to do, but I can't find the discipline to do it." " I am spread to thin and stressed out." Does this carry over into any other aspects of your life? Anything goes here.
Which of the following best describe you?
How many years have been doing your sport?
What is your level of interest? Answer all that apply.
Finally a couple of questions to help me organize the surveys. How should I address you?
What is your age group?
Do you have any other comments, questions or concerns about your health, performance or nutrition? Add as much detail as you would like.