#SPORTS NUTRITION Advanced Sports Nutrition supplements


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Please fill out form as correctly as possible to enable us to serve you better:

Date :

First Name :

Last Name :

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Age :

Gender :

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Daytime or work Phone :

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Why are you looking for a personal fitness trainer or registered dietitian?
Please check all that apply below, or use the box to enter any other reasons.

	Fat or Weight Loss
	Muscle Gain
	Improve my workouts
	Want to learn more about Fitness and/or Nutrition
	Recommended by Physician, Physical Therapist, or other healthcare professional.
	Need Sports-specific training
	Heal injury

Other Training Reasons

Please give a brief description of the health and fitness goals you are trying to achieve or improve .

Energy :


1- How are your energy levels throughout the day?

2- Do you need more energy or stamina during your workouts?	yes	no

3- Do you get sleepy or lethargic after eating?	yes	no

NUTRITION

SUPPLEMENTATION

DIGESTION


1- How is your digestion? Indicate the number of daily bowel movements.


2- Do you suffer from indigestion or have any gastro-intestinal problems?	yes	no

Fitness :

Rest :

1- How many hours of sleep do you get on an average night?

2- What time do you generally go to bed?

3- What time do you generally wake up?

4- Do you suffer from insomnia or have trouble sleeping?	yes	no

GENERAL HEALTH

Height:

Current Weight:

Weight 1 year ago:

1- How much weight would you like to lose?

2- How much weight would you like to gain?

3- Do you consider yourself to have a high stress level?	yes	no

4- Is your total cholesterol greater than 200?

5- Do you suffer from weak bones and/or joints?	yes	no

6- Do you smoke?	yes	no

7- If you smoke, how many packs per day?

8- Do you drink alcohol?	yes	no

9- If you drink alcohol, how many drinks per week?

WOMEN'S HEALTH


1- Are you post-menopausal?	yes	no

2- Do you suffer from hot flashes?	yes	no

3- Are you pregnant or lactating?	yes	no

MEDICAL INFORMATION

Thank you for filling out our questionnaire. We will e-mail you within 24-48 hours with an initial consultation. This is a no spam zone and we truly respect your internet privacy. We do not share your information with any other individuals, companies or web sites. All information included in this questionnaire is held strictly confidential.

By clicking on submit below, I certify that i am over the age of 18 and have read and fully understand the contents and the disclaimer and agree to its terms and conditions in full.

If i have a medical condition, and/or if i am currently taking prescribed medications, it is recommended that the use of nutritional supplements should be coordinated with my physician or a registered dietitian. Some nutritional supplements may interact with medical conditions or prescribed medications.

Thank you for your time!

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Contract

Manufacturing

A Profitable Partnership

For over a decade , we have helped companies enhance their profitability by diversifying the variety of items they carry to reach a wider spectrum of customers

Customized Program

At Advanced Sports Nutrition, we provide you with the Support, Knowledge, Motivation & Skills needed to achieve your optimum fitness level, improve your physique and overall health, you'll also improve your self-esteem as well!

Sports Supplements

There is a lot of misconception on Sports Nutrition Supplements and its effect on health, especially in the Middle Eastern part of the world where Sports Nutrition Supplements are relatively a new concept.

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