Background Information
Participant First Name and Middle Initial____________________________________________
Participant Number (assign by researcher)____________________________________________
Fran Time Pre-Test (Recorded by Researcher)___________________
What is your gender? Male = 1 Female = 2
What is your age?__________________
What is your weight?_______________
What is your height?_______________
How many days do you exercise per week? 1 2 3 4 5 6 7
How many days per week do you eat fast food? 1 2 3 4 5 6 7
How many days per week do you eat fried foods? 1 2 3 4 5 6 7
How many days per week do you eat flour (bread, pasta)? 1 2 3 4 5 6 7
How many days per week do you consume sugar? 1 2 3 4 5 6 7
Do you take pre and post workout supplements? Yes = 1 No = 2
TO BE FILLED OUT ON THE LAST DAY OF THE STUDY
How many training days did you miss during this study? 1 2 3 4 5+
How many cheat meals days did you have during this study? 1 2 3 4 5+
Time on “Fran” WOD (post-test)________________