The Foundational Athlete

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Section 1 — Athlete Information

Athlete First Name

Athlete Last Name

Date of Birth

Age

Gender

School / Team / Club

Height

Weight (lbs)

Body Composition Goal

Parent / Guardian (if under 18)

Parent / Guardian Name

Relationship to Athlete

Parent Email

Parent Phone

Athlete Email (if applicable)

Athlete Cell (if applicable)

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Section 2 — Sport & Training

Primary Sport

Events / Position

Competitive Level

Season Status

Training Days Per Week

Avg Session Length

Practice Timing

Strength Training?

Describe a Typical Training Week

Coach Name & Contact (optional)

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Section 4 — Hydration

Daily Water Intake

Drinks During Practice / Competition?

Experiences Cramping During Exercise?

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Section 5 — Health & Medical History

Confidential: This information is used only to personalize your nutrition plan and is kept strictly private.

Any Current Injuries?

If Yes, Describe

Any Chronic Conditions?

If Yes, Describe

Any Current Medications or Supplements?

If Yes, Please List

For Female Athletes

Why we ask: Menstrual cycle health directly impacts energy, iron levels, bone health, and performance. This helps us build a plan that fully supports the female athlete.

Has Menstruation Begun?

Is the Cycle Regular?

History of Low Iron / Anemia?

Any Concerns About Bone Health or Stress Fractures?

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Section 6 — Performance & Goals

Event / PR #1

Event / PR #2

Event / PR #3

Event / PR #4 (if applicable)

Performance Goals This Season

Primary Nutrition Goals

Improve energy levels Improve race performance Faster recovery Build muscle / strength Improve body composition Reduce GI issues during competition Learn macro tracking Reduce fatigue / burnout Build better habits overall

What Is Currently Holding Back Performance?

Rate 1–10

Daily Energy Levels

Low5

110

Recovery Between Sessions

Poor5

110

Sleep Quality

Poor5

110

Satisfaction With Current Nutrition

Poor5

110

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Section 7 — Sleep & Lifestyle

Average Hours of Sleep Per Night

Feels Rested When Waking?

Screen Time Before Bed?

Other Activities Outside Training

Recovery Tools Currently Used

Compression boots Firefly device Epsom salt baths Ice bath / cold plunge Massage / foam rolling Stretching / yoga None currently

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Section 8 — Additional Notes & How You Found Us

How Did You Hear About Pure Balance Athletic Co.?

Referral from a friend or family Coach or trainer recommendation Social media Google search School or team Other

If Referred, Who Referred You? (Optional)

Anything Specific You'd Like Us to Know Before Your First Session?

What Does Success Look Like to You at the End of This Program?

Consent & Signature

I confirm the information provided is accurate to the best of my knowledge. I understand that Pure Balance Athletic Co. provides sports nutrition coaching, not medical advice. I will consult a physician for medical concerns. I give consent for my athlete's information to be used to create a personalized nutrition plan.

Parent or guardian signature required for athletes under 18.

Parent / Guardian Signature (Type Full Name)

Date

Your information is confidential and will be reviewed before your first session.
Questions? Call or text us at 858-753-8788

Thank you! We've received your questionnaire.

Kristie will review your information and reach out to confirm your first session.
Feel free to call or text 858-753-8788 with any questions.

Ready to Join the Foundational Athlete Team?

Athlete Intake Questionnaire

Thank you! We've received your questionnaire.

Ready to learn more and start your journey?