Nutrition Questionnaire

First Name

Last Name

Address

Address Line 1

City

State

Zip Code

Country

Email

Phone Number

Date of Birth

Age

Gender

Male

Female

Marital status

Single

Married

Divorced

Do you have children?

Yes

No

Occupation

Hours per week that you work

How did you hear about us?

What is your athletic background?

Height

Weight

When was your last blood work testing done?

Do you follow a specific or special diet?

Body composition (fat %)

How was your body composition measured?

What is your body weight history?

List foods that you dislike or will not eat

Do you like to cook?

Yes

No

How often do you eat out?

How much fluid do you consume daily?

What types of fluids do you drink?

Have you had any issues with training and race nutrition or hydration?

Are you familiar with the Metabolic Efficiency Training concept?

Yes

No

What are your top 3 short term goals?

How will you define success?

Anything else you'd like your coach to know?