Client Intake · Dancer-Athlete

Before we build your plan

Fill in what you know now. Anything you're not sure about, skip it — a parent or guardian will finish the rest.

About You

What's your name?

How old are you?

What kind of dance do you do?

Ballet

Contemporary

Jazz

Hip Hop

Competition

Other

How many years have you been dancing?

Your Training Week

How many days a week do you train or rehearse?

About how many hours on a typical training day?

Do you do any other sports or activities?

A Day of Eating

Walk us through a typical TRAINING day — what do you usually eat and when?

What about a REST day — how's it different?

Any foods you don't like or can't eat?

Do you ever feel low energy, shaky, or dizzy during the day? When does that happen?

How You Feel

How do you feel about food and eating, generally? Honest answer helps most

What would you want more energy for — a skill, stamina, focus, something else?

About how many hours do you usually sleep?

How much water do you usually drink on a training day?

A few questions below touch on growth and health history. Please answer only what's medically relevant — this stays confidential and is used only to build a safe, appropriately-fueled plan.

Contact & Care Team

Parent/guardian name

Best contact (email or phone)

Pediatrician or other care providers involved

Date of most recent physical / check-up

Health Background

Any known growth or development concerns from her pediatrician? Optional

Any history of missed or irregular menstrual cycles, if applicable? Optional · Confidential

Diagnosed medical conditions, food allergies, or intolerances

Current medications or supplements

Past injuries (e.g. stress fractures, tendonitis)

Home & Support

Who usually prepares her food?

Has anyone — coach, teacher, peer — made comments about her body or eating that she's mentioned at home?

What does your family hope this plan supports?

Anything else we should know before building her plan?

Review Before Sending

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