Full Name
Date
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Month
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Day
Year
Date
Email
*
example@example.com
Who recommended you to VIGEO Health? If you give us their full name, and a phone number, email address, or physical address, we will send them a $20 Amazon gift card as a thank you!
What sports do you compete in?
Do you race for fun or are you competitive?
Are you under WADA rules and regulations?
Please Select
Yes
No
How long have you been competing?
How often do you race?
What are your goals?
Existing or previous injuries?
How many days a week do you exercise?
How many hours a week do you exercise?
What is your typical diet? (Foods you generally eat in an average 48 hour period)
Breakfast?
Lunch?
Dinner?
Snacks?
What is the worst thing you eat? How often?
Have you tried any specific diets? (i.e. Keto, Vegan, Paleo, etc)
Do you have any dietary restrictions?
Do you change your diet in the week before a race? How?
How much water do you drink throughout the day?
What other liquids do you drink? (Ex. Soda, Diet Soda, Energy Drinks, Coffee, Fruit Juice, Tea, etc.)
Do you restrict salt?
Please Select
Yes
No
Do you track your sleep and exercise with a wearable? (Ex. Oura Ring, Apple Watch, etc)
What are your pre race strategies?
What fueling do you use during your races or workouts?
What has worked for fueling and what hasn't?
Do you feel like you can sustain energy levels throughout a race?
Please Select
Yes
No
Do you hit a wall? At what point?
Do you have stomach issues or cramping?
What's your biggest challenge on race day? Or during training?
Do you have GI distress during races?
Have you tried BPC-157 or other peptides for injury or athletic performance?
Please Select
Yes
No
Athlete Self-Care
Massage
Sauna
Cold Plunge
Foam Rolling
PEMF
Red-Light Laser
Other
Would you be interested in any other services from VIGEO Health?
Nutritional Counseling
Cooking Classes
Weekly Q&A Zoom Call
Life Coaching
Health Coaching
Anything else that is pertinent and you want to share?
Date
/
Month
/
Day
Year
Date
What injuries do you have? Describe in detail: Injury When, Location, Duration, Chronic or Acute?
Is it a direct (bruises, direct contact or collision) injury or indirect (no contact, muscles strains, overtraining, etc.) injury?
What have you tried already to try and fix this/these?
What sports do you compete in?
Have you had any surgeries?
As an athlete do you fall under WADA guidance?
Please Select
Yes
No
Do certain activities make it worse?
Have you had an x ray or MRI to confirm the extent of the injury?
Please Select
Yes
No
Have you tried any other supplements or treatments prior to this?
Has anything in the past help relieve the pain (rest, ice, compression, or elevate)?
Do you feel like you stay well hydrated?
Please Select
Yes
No
Have you used peptides before?
Please Select
Yes
No
Anything else that is pertinent and you want to share?
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