Nutrition Questionnaire - CKM Sports Management

Name *

First

Last

Height and Weight

What position(s) do you play?

What is your overall health goal?

Do you want to change your body composition by increasing or decreasing your weight?

If yes, please explain why you want to change your body composition?

Do you have any current health concerns?

Do you have any medical conditions?

Are you currently taking and medications?

Generally, how often do you travel? (outside of hockey)

On average, how many days a week are active?

Are you currently in training season or competition season?

How would you describe your current diet?

Do you have any allergies or sensitivities?

How many meals do you normally eat in a day?

How many snacks do you normally eat in a day?

What foods do you typically eat for: A) Breakfest B) Lunch C) Dinner D) Snack

What are your favorite foods?

What foods do you avoid or dislike?

Do you typically prepare your own meals?

If you don't prepare meals, who typically does?

How do you typically eat meals?

Do you feel there are restrictions to your diet due to preferences of others such as family, roommates, etc? If yes, please explain.

Do you experience any symptoms if meals are missed? Explain:

Do you experience any symptoms after meals? Explain

How many glasses of water do you typically drink in a day?

How many caffeinated beverages (e.g. coffee, tea, pop) do you tend to drink in a day?

How often do you consume sports drinks?

How often do you drink alcohol?

How many alcoholic beverages do you tend to consume when you drink?

Are you currently taking any supplements (including protein powder)? If so, please list, including brand, how often and dosage:

Do you have any digestive concerns?

On average, how many hours do you sleep a night?

Do you have any troubles sleeping (e.g. falling asleep, staying asleep, etc.)?

On a scale of 1 to 10 (1 being little or no stress, 10 being very stressed), what level of stress do you feel you are experiencing at this time?

What coping mechanisms do you use?

On a scale of 1 to 10 (1 being little energy, 10 being a lot of energy), how would you rate your energy levels on an average day?

Do you experience energy lulls in the day? If so, what time of day?

Are you consistently able to focus during training or competition or do you find it challenging to focus?

How would you describe your ability to concentrate and focus in other aspects of your life (e.g. school).