Client Name:       Title:

Contact Information:
To maintain confidentiality, the email above is where the research findings will be emailed.

Last Virtual Research Contract Date (from this research service provider):

RESEARCH FOCUS: Here, specify the focus of the research requesting. If left blank, these factors may not be considered for the findings:

Work Hours:      Distant Travel "To" Work Daily:

Age Group:     Gender:      Weight:     Height: 

Blood Pressure:   Recent Blood Work (Results):

Environmental Allergies: Topical/Skin Allergies:

Medications Intake (Dose/Frequency) Effect:

Supplement Intake (Dose/Frequency) Effect:

Indicated Type of Athlete/Fitness: Recreational/non-competitive--Professional Sport Athlete--Strength Athlete--Power Athlete--Endurance Athlete--Military Training:

Proposed Origin/Trigger of Body Stress:

Female Research Focus Only: Pregnant/Menstrual Duration/Flow:

Instructions: Type An Explanation/Focus After Inquiry. Do Not Remove the Text in the Textbox:

Did you follow the suggestions provided from our last virtual session? Explain.

Case 1: Primary Work Activity Causing Stress (Same, Improved, or Worsen ~ Explain):

Case 2: Interaction with Coach/Trainer (Same, Improved, or Worsen ~ Explain):

Case 3: Interaction with Team Members (Same, Improved, or Worsen ~ Explain):

Symptom 1 ~ Physical ~ Stated Last Virtual Session (Explain~Same, Improved, or Worsen/Describe~Location, Duration, Frequency):

Symptom 2 ~ Mental ~ Stated Last Virtual Session (Explain~Same, Improved, or Worsen/Describe~Location, Duration, Frequency):

Symptom 3 ~ Emotional ~ Stated Last Virtual Session (Explain~Same, Improved, or Worsen/Describe~Location, Duration, Frequency):

Symptom 4 ~ Other ~ Stated Last Virtual Session (Explain~Same, Improved, or Worsen/ Describe~Location, Duration, Frequency):

Symptom 6 ~ New ~ Describe~Location, Duration, Frequency:

By pressing the submit button, I agree to the terms indicated on the Sports/Fitness Body Stress Research~Followup webpage (Brigette's Natural Healthcare Academia Research Firm~hereby known as the "Firm") and with the payment terms. I also certify that all the information presented in this submission is true, and I consent to the use of disclosure of the information submitted for healthcare research services. I acknowledge that the email address provided is secure, and that the Firm cannot and will not be held liable for any breach in the email system or of the information or misinformation transmitted using this electronic platform. I further understand the Firm cannot or will not be held legally liable for any symptoms (prior, current, future) to include symptoms that have been indicated or omitted in this transmission associated with the condition or disease of which is being researched. This Service Agreement and any dispute there under shall be governed by the laws of the State of Georgia, USA.