Unlimited Sports Management's Health and Performance Form

• Name
  Prénom Nom
• Date of birth
• Age
• Weight (pounds)
• Height (Feet)
  (Ex. 5'10 )
• Email
• Phone
• Address
  Adresse postale Adresse ligne 2 Ville État / Province / Région ZIP / Code postal AfghanistanÅland IslandsAlbanieAlgérieSamoa américainesAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArgentineArménieArubaAustralieAutricheAzerbaïdjanBahamasBahreïnBangladeshLa BarbadeBelarusBelgiqueBelizeBéninBermudesBhoutanBolivieBonaire, Sint Eustatius and SabaBosnie-HerzégovineBotswanaBouvet IslandBrésilBritish Indian Ocean TerritoryBrunei DarrussalamBulgarieBurkina FasoBurundiCambodgeCamerounCanadaCap-VertÎles CaymanRépublique centrafricaineTchadChiliChineChristmas IslandCocos IslandsColombieComoresRépublique démocratique du CongoRépublique du CongoCook IslandsCosta RicaCôte d’IvoireCroatieCubaCuraçaoChypreRépublique tchèqueDanemarkDjiboutiDominiqueRépublique DominicaineÉquateurÉgypteSalvadorGuinée équatorialeÉrythréeEstonieEswatini (Swaziland)ÉthiopieFalkland IslandsÎles FéroéFidjiFinlandeFranceFrench GuianaPolynésie françaiseFrench Southern TerritoriesGabonGambieGéorgieAllemagneGhanaGibraltarGrèceGroenlandGrenadeGuadeloupeGuamGuatemalaGuernseyGuinéeGuinée-BissauGuyaneHaïtiHeard and McDonald IslandsHoly SeeHondurasHong KongHongrieIslandeIndeIndonésieIranIrakIrlandeIsle of ManIsraëlItalieJamaïqueJaponJerseyJordanieKazakhstanKenyaKiribatiKoweïtKirghizistanLao People's Democratic RepublicLettonieLibanLesothoLiberiaLibyeLiechtensteinLituanieLuxembourgMacauMacédoineMadagascarMalawiMalaisieMaldivesMaliMalteÎles MarshallMartiniqueMauritanieÎle MauriceMayotteMexiqueMicronésieMoldavieMonacoMongolieMonténégroMontserratMarocMozambiqueMyanmarNamibieNauruNépalPays-BasNew CaledoniaNouvelle-ZélandeNicaraguaNigerNigériaNiueNorfolk IslandCorée du NordÎles Mariannes du NordNorvègeOmanPakistanPalauÉtat palestinienPanamaPapouasie-Nouvelle-GuinéeParaguayPérouPhilippinesPitcairnPolognePortugalPorto RicoQatarRéunionRoumanieRussieRwandaSaint BarthélemySaint HelenaSaint-Christophe-et-NevisSainte-LucieSaint MartinSaint Pierre and MiquelonSaint-Vincent-et-les GrenadinesSamoaSaint-MarinSao Tomé et PrincipeArabie SaouditeSénégalSerbieSeychellesSierra LeoneSingapourSint MaartenSlovaquieSlovénieÎles SalomonSomalieAfrique du SudSouth GeorgiaCorée du SudSouth SudanEspagneSri LankaSoudanSurinameSvalbard and Jan Mayen IslandsSuèdeSuisseSyrieTaïwanTadjikistanTanzanieThaïlandeTimor-LesteTogoTokelauTongaTrinité et TobagoTunisieTurquieTurkménistanTurks and Caicos IslandsTuvaluOugandaUkraineÉmirats arabes unisRoyaume-UniÉtats-UnisUruguayUS Minor Outlying IslandsOuzbékistanVanuatuVenezuelaVietnamÎles Vierges britanniquesÎles Vierges américainesWallis and FutunaWestern SaharaYémenZambieZimbabwe Pays
• What are your goals in hockey? (Short and long-term)
• What would you like to improve as an athlete?
  ( Ex: Strength, muscle mass, power, speed, recovery, energy...)

• Part 1 : Digestive system and immune system

• Digestive system: Click on the signs & symptoms you have or you have had in the last 30 days.
  • Excessive yawning
  • Gall bladder stone
  • Stomach cramp
  • Stomach burn
  • Diarrhea
  • Constitpation/
  • Alternance of diarrhea and constipation
  • Gaz, bloating
  • Dont eat a lot
  • Still feel hungry after eating
• Immune system: Do you often get a cold or the flu during a hockey season? If so, how frequently? (approximately)
• Immune system: Have you ever taken antibiotics? If so, for how long and for how many times? (approximately)

• Part 2: Musculoskeletal system and training recovery

• Musculoskeletal system and training recovery: Click on the signs & symptoms you have or you have had in the last 30 days.
  • Muscle cramps
  • Joints' stiffness
  • Difficulty to gain muscle mass
  • Difficulty to focus
  • Memory loss
  • Slow recovery from training ( Ex. Long delayed onset muscle soreness (DOMS) from strength training)
  • Insufficiant work capacity (Get tired easily with metabolic work surch as aerobic/cardio work)
  • Lack of endurance strength (Get tired easily with muscular work)
  • Lack of strength
  • Lack of power
  • Slow recovery from a physical injury (Takes more time than it should to recover)

• Part 3: Sleep and energy

• Sleep
  • Difficult to fall asleep
  • Wake up at night (one to several times)
  • Still tired even after a full night of sleep
  • I often dream.
  • I often have nightmares.
  • I have muscle cramps at night.
• Energy: Out of 10, how's your level of energy in the morning?
  Please enter a number from 1 to 10.
  1: Extremely tired 10: Very energetic
• Energy: Out of 10, how's your level of energy at noon?
  1: Extremely tired 10: Very energetic
• Energy: Out of 10, how's your energy at 3:00 o'clock PM?
  1: Extremely tired 10: Very energetic
• Energy: Out of 10, how's your energy at 8:00 o'clock PM?
  1: Extremely tired 10: Very energetic

• Part 3: Supplements and food plan

• Do you take supplements?
  YesNo
• If so, what do you take? (company name, product, posology)
  Ex. Ortho Molecular Products, Mitocore (multi-vitamins), 2X AM

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