First Name*

Last Name*

E-mail Address

Birthdate*

Gender
FemaleMale

Please provide Instagram handle

Have you previously participated in any sports performance training?*
YesNo

What is your primary sport?*
BaseballBasketballCheerleadingDanceFootballGolfGymnasticsHockeyLacrosseRugbySkiingSoccerSoftballSwimmingTennisTrack&Field/Cross CountryVolleyballWrestlingOther

If other, please list:

Please list your school and/or club organizations, if applicable.

How many times do you practice/exercise per week?*

Can we contact your coach to discuss our sports performance training?*

Yes No I do not have a coach Not Applicable

If yes, please provide coach contact information:

Have you been injured in the last year?*

Yes No

If yes, please provide date and type of injury:

Have you ever had an injury that required surgery?*

Yes No

If yes, please list the surgery.

If applicable, for any current or previous orthopedic injuries/conditions, who is/was your Orthopedic Surgeon?*

Any past or present nutrition related concerns?*

Yes No

If yes, please explain:

Do you follow a special diet or have any food allergies/intolerances?*

Yes No

If yes, please explain:

What is your sports nutrition goal?
Lean outGain muscleInjury recovery (stress fracture, soft tissue tear, Broken bone, concussion, etc.)Improve performanceSport fueling planningDigestive distressPositive body imageBody composition trackingMeal planningOther

We offer Sports Nutrition services. Are you interested in being contacted by our Sports Dietitian?
YesNo

What services are you seeking from the Training HAUS? Please select all that apply.
AccupunctureBio mechanics LabChiropractorFitness ClassesMassageNutritionOtherPhysical TherapyReturn to Sport (ACE)Sports Performance

If other, please list;

How did you hear about the Training HAUS?*
Online/WebsiteSocial MediaEventMedical ProviderClub/Coach/SchoolCurrent HAUS AthleteHAUS or TCO EmployeeAdvertisingOther

If referred by an employee, please provide name:

When training with HAUS strength coaches, where will you primarily train?

Training HAUS - Eagan TCO Eden Prairie TCO Edina TCO Waconia Therapy and Sports Performance TCO Woodbury Other

We offer Sport Psych services. Are you interested?

Yes No

If yes, do you consent to sharing your information with Premier Sport Psychology?
YesNo

I am age 18 or the parent/guardian of the athlete:*

Yes No

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