Sports and Nutrition Consultation – Dr Ashkan Masoumain

Please complete the following profile carefully

Page 1 of 5

Course selection*

Choose a package*

Dear user, the private course you have selected is only available for Tehran and Muscat (Oman). If you do not reside in these locations, please consider using the online course. Thank you

Dear user, the group course you have selected is currently not available. We apologize for the inconvenience. Please consider using private or online courses instead. Thank you

First and last name*

First name

Last name

Height (cm)*

Weight in the past one and two months (kg)*

Waist circumference (measured from the navel at maximum diameter) (cm)*

Hip circumference (maximum diameter) (cm)*

Arm circumference (with maximum contraction, measured at the midpoint of the arm) (cm)*

Age (years)*

Current weight (kg)*

Neck circumference (minimum diameter) (cm)*

Arm circumference (without contraction, measured at the midpoint of the arm) (cm)*

Thigh circumference (mid-thigh, distance between knee joint line and bone prominence) (cm)*

Do you have any pain or specific medical conditions؟*

آرتروز، دیسک کمر، دیابت و غیره

Yes

Other

Your type of illness*

Do you lose your balance due to dizziness?*

Yes

Have you been prescribed blood pressure medication or heart disease medication?*

Yes

Do you feel any chest pain?*

Yes

Do you have any joint issues such as unusual sounds in the joints?*

Yes

Describe please

Weekly activity level (min)*

چند جلسه تمرین روز و ساعت هر روز

How long has it been since the start of your regular exercise program?*

یک هفته، یک ماه

Type of physical activities/exercises*

بدنسازی، کوهنوردی و غیره

Do you use any medications or drugs?*

Yes

Duration of the course and dosage

Do you have any allergies to supplements or specific foods?*

Yes

Describe please

What type of meat do you consume?*

Sheep

Chicken

Goat

camel

turkey

Rabbit

Fish

Shrimp and crab

What is your favorite food?*

Sexual activity level during the week*

How many hours do you use electronic devices during the day?*

تلویزیون، موبایل، لپ تاپ و غیره

What is your hate food?*

Amount of sleep during the day (hours)*

Amount of study (hours)*

Upload a full-body photo from the lateral (side) view*

Maximum size 10MB. jpg, jpeg, png, gif

Upload a full-body photo from the frontal (front-facing) view*

Maximum size 10MB. jpg, jpeg, png, gif

Upload a full-body photo from the posterior (back-facing) view*

Maximum size 10MB. jpg, jpeg, png, gif

If you have blood tests and body composition results, please upload them

Maximum size 10MB. jpg, jpeg, png, gif,pdf

If you have any workout or nutrition plans from the past six months or one year, please upload them

Maximum size 10MB. jpg, jpeg, png, gif,pdf

Your job*

Number of working hours during the day (hours)*

What type of exercise do you prefer the most?*

کوهنوردی، دوچرخه سواری، شنا، اسکی و غیره

What is your goal in exercising?*

Volume

Fat burning

Correctional

Other

Do you mentally prepare yourself for a tough and challenging workout?*

Yes

Describe please

Your address*

Gym name

Mobile phone number*

Landline phone number*

Email address*

Please provide details about your lifestyle and nutrition habits, such as the number of meals and snacks, types of foods, meal timing, etc.*

Please type the characters*

This field should be left blank

Please complete the following profile carefully

Page 1 of 5

Course selection*

Choose a package*

Dear user, the private course you have selected is only available for Tehran and Muscat (Oman). If you do not reside in these locations, please consider using the online course. Thank you

Dear user, the group course you have selected is currently not available. We apologize for the inconvenience. Please consider using private or online courses instead. Thank you

First and last name*

First name

Last name

Height (cm)*

Weight in the past one and two months (kg)*

Waist circumference (measured from the navel at maximum diameter) (cm)*

Hip circumference (maximum diameter) (cm)*

Arm circumference (with maximum contraction, measured at the midpoint of the arm) (cm)*

Age (years)*

Current weight (kg)*

Neck circumference (minimum diameter) (cm)*

Arm circumference (without contraction, measured at the midpoint of the arm) (cm)*

Thigh circumference (mid-thigh, distance between knee joint line and bone prominence) (cm)*

Do you have any pain or specific medical conditions؟*

آرتروز، دیسک کمر، دیابت و غیره

Yes

Other

Your type of illness*

Do you lose your balance due to dizziness?*

Yes

Have you been prescribed blood pressure medication or heart disease medication?*

Yes

Do you feel any chest pain?*

Yes

Do you have any joint issues such as unusual sounds in the joints?*

Yes

Describe please

Weekly activity level (min)*

چند جلسه تمرین روز و ساعت هر روز

How long has it been since the start of your regular exercise program?*

یک هفته، یک ماه

Type of physical activities/exercises*

بدنسازی، کوهنوردی و غیره

Do you use any medications or drugs?*

Yes

Duration of the course and dosage

Do you have any allergies to supplements or specific foods?*

Yes

Describe please

What type of meat do you consume?*

Sheep

Chicken

Goat

camel

turkey

Rabbit

Fish

Shrimp and crab

What is your favorite food?*

Sexual activity level during the week*

How many hours do you use electronic devices during the day?*

تلویزیون، موبایل، لپ تاپ و غیره

What is your hate food?*

Amount of sleep during the day (hours)*

Amount of study (hours)*

Upload a full-body photo from the lateral (side) view*

Maximum size 10MB. jpg, jpeg, png, gif

Upload a full-body photo from the frontal (front-facing) view*

Maximum size 10MB. jpg, jpeg, png, gif

Upload a full-body photo from the posterior (back-facing) view*

Maximum size 10MB. jpg, jpeg, png, gif

If you have blood tests and body composition results, please upload them

Maximum size 10MB. jpg, jpeg, png, gif,pdf

If you have any workout or nutrition plans from the past six months or one year, please upload them

Maximum size 10MB. jpg, jpeg, png, gif,pdf

Your job*

Number of working hours during the day (hours)*

What type of exercise do you prefer the most?*

کوهنوردی، دوچرخه سواری، شنا، اسکی و غیره

What is your goal in exercising?*

Volume

Fat burning

Correctional

Other

Do you mentally prepare yourself for a tough and challenging workout?*

Yes

Describe please

Your address*

Gym name

Mobile phone number*

Landline phone number*

Email address*

Please provide details about your lifestyle and nutrition habits, such as the number of meals and snacks, types of foods, meal timing, etc.*

Please type the characters*

This field should be left blank

Please complete the following profile carefully

Page 1 of 5

Course selection*

Choose a package*

Dear user, the private course you have selected is only available for Tehran and Muscat (Oman). If you do not reside in these locations, please consider using the online course. Thank you

Dear user, the group course you have selected is currently not available. We apologize for the inconvenience. Please consider using private or online courses instead. Thank you

First and last name*

First name

Last name

Height (cm)*

Weight in the past one and two months (kg)*

Waist circumference (measured from the navel at maximum diameter) (cm)*

Hip circumference (maximum diameter) (cm)*

Arm circumference (with maximum contraction, measured at the midpoint of the arm) (cm)*

Age (years)*

Current weight (kg)*

Neck circumference (minimum diameter) (cm)*

Arm circumference (without contraction, measured at the midpoint of the arm) (cm)*

Thigh circumference (mid-thigh, distance between knee joint line and bone prominence) (cm)*

Do you have any pain or specific medical conditions؟*

آرتروز، دیسک کمر، دیابت و غیره

Yes

Other

Your type of illness*

Do you lose your balance due to dizziness?*

Yes

Have you been prescribed blood pressure medication or heart disease medication?*

Yes

Do you feel any chest pain?*

Yes

Do you have any joint issues such as unusual sounds in the joints?*

Yes

Describe please

Weekly activity level (min)*

چند جلسه تمرین روز و ساعت هر روز

How long has it been since the start of your regular exercise program?*

یک هفته، یک ماه

Type of physical activities/exercises*

بدنسازی، کوهنوردی و غیره

Do you use any medications or drugs?*

Yes

Duration of the course and dosage

Do you have any allergies to supplements or specific foods?*

Yes

Describe please

What type of meat do you consume?*

Sheep

Chicken

Goat

camel

turkey

Rabbit

Fish

Shrimp and crab

What is your favorite food?*

Sexual activity level during the week*

How many hours do you use electronic devices during the day?*

تلویزیون، موبایل، لپ تاپ و غیره

What is your hate food?*

Amount of sleep during the day (hours)*

Amount of study (hours)*

Upload a full-body photo from the lateral (side) view*

Maximum size 10MB. jpg, jpeg, png, gif

Upload a full-body photo from the frontal (front-facing) view*

Maximum size 10MB. jpg, jpeg, png, gif

Upload a full-body photo from the posterior (back-facing) view*

Maximum size 10MB. jpg, jpeg, png, gif

If you have blood tests and body composition results, please upload them

Maximum size 10MB. jpg, jpeg, png, gif,pdf

If you have any workout or nutrition plans from the past six months or one year, please upload them

Maximum size 10MB. jpg, jpeg, png, gif,pdf

Your job*

Number of working hours during the day (hours)*

What type of exercise do you prefer the most?*

کوهنوردی، دوچرخه سواری، شنا، اسکی و غیره

What is your goal in exercising?*

Volume

Fat burning

Correctional

Other

Do you mentally prepare yourself for a tough and challenging workout?*

Yes

Describe please

Your address*

Gym name

Mobile phone number*

Landline phone number*

Email address*

Please provide details about your lifestyle and nutrition habits, such as the number of meals and snacks, types of foods, meal timing, etc.*

Please type the characters*

This field should be left blank