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ULTIMATE SPORT SCIENCE APPLICATION
Please fill out the following form in order to participate in our activity.
Personal Information
First Name
Date of Birth
Height
Preference lateral dominance?
Right
Left
Field position
Last Name
Id/Dni/Passport
Email
Phone
Weight
Have you been hospitalized in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness, or injury?
No
Yes
If you answered yes to any question, please elaborate
Sport Activity and sport supplements
What is your relaton with sports? environment/Cual es tu relacion con el deporte?
Choose an option
How many practices per week?/Cuantos entrenamientos realizas por semana?
Choose an option
How long last the practices on average?/Cuanto duran los entrenamientos de media?
Choose an option
What are your main areas of improvements?/Cuales son tus objetivos de mejora?
Speed/Velocidad
Endurence/ Resistencia
Forze/Fuerza
Weight increase or reduction/Incremento o reduccion de peso
Stretching/ Estiramientos
Do you use any suplemental products
No
Yes
Do you preffer natural/homemade or synthetic supplemets?
Natural
synthetic
Improvement first
Name the product(if any)
Provide supporting details to accurately understand your needs in your areas of improvements/ Indica detalles para entender mejor tus necesidades
Nutritional facts & Liquid intake
How much Kcal ingest per day on average?/Cuantas Kcal ingieres por dia de media?
Choose an option
How many food ingested per day?/Cuantas veces ingieres comida por dia?
Choose an option
Do you eat unhealthy or fast food frequently?
No
Yes
Do you abuse of any kind of food?
No
Yes
Please complete the chart bellow assigning a punctuation based on the average of products you intake in your diet during one week of period.
Meats(Beef or pork)
One per week
Two per week
Three per week
Four per week
Five or more
Meats(Chicken or Turkey)
One per week
Two per week
Three per week
Four per week
Five or more
Fish
One per week
Two per week
Three per week
Four per week
Five or more
Fruits
One per week
Two per week
Three per week
Four per week
Five or more
Cereals
One per week
Two per week
Three per week
Four per week
Five or more
Legumes
One per week
Two per week
Three per week
Four per week
Five or more
Vegetables
One per week
Two per week
Three per week
Four per week
Five or more
Nuts
One per week
Two per week
Three per week
Four per week
Five or more
Dairy
One per week
Two per week
Three per week
Four per week
Five or more
How many liters of water do you drink per day?/Cuantos litros de agua bebes por dia?
Choose an option
How many liters of other non carbonated liquids do you drink (other than water)?
Choose an option
Do you drink caffeinated beverages?
No
Yes
sometimes
Do you drink alcohol?/Tomas alcohol?
No
Yes
Sometimes
Complete the information provided and add valuable infomation about liquid intake and nutritional facts that affect to your sport performance(if any)
Sleep quality information
How many hours do you sleep per day on average?
Choose an option
Do you have sleep interruptions?
No
Yes
How many times do you interrupt your sleep per night?
Choose an option
Do you have any electronic devide in your bedroom or next to your bed?
No
Yes
Do you turn your phone off at nigh?
No
Yes
Today's date
I declare that the info I’ve provided is accurate & complete
I accept terms & conditions
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