Please complete all sections before your first session. This helps us build a nutrition plan that is personalized, safe, and aligned with your specific goals. All information is kept strictly confidential.
⚖️Lose WeightFat loss, body composition
💪Build MuscleStrength, lean mass
🥗Eat HealthierEnergy, digestion, habits
Describe your goal in your own words
Do you have any of the following? (check all that apply)
✓
Joint / injury limitations
Current medications or supplements (if any)
Any food allergies or intolerances?
Are you currently under a doctor's care for any condition?
How many meals do you eat per day?
Do you eat breakfast regularly?
Which of the following do you currently eat regularly? (check all that apply)
✓
Packaged / processed snacks✓
Restaurant meals 3+/week
Current activity level
Primary type of exercise
Average hours of sleep per night
Daily water intake
Daily stress level
Low
High
Have you tried a structured nutrition program before?
If yes — what worked, and what didn't?
Biggest challenge when it comes to eating well
How ready are you to make changes right now?
Not ready
100% in
Anything else we should know before your first session?
Pure Balance Athletic Co. provides nutrition education and meal planning guidance. Our services are not a substitute for medical advice, diagnosis, or treatment. By submitting this form, you confirm that you have disclosed any known health conditions and agree to consult your physician before making significant dietary changes if medically warranted.
