NUTRITION

Metabolic Balance Paperwork

Please note…

These guidelines are in place for your protection and ours, as we strive to serve you to the best of our ability.

Please arrive at least 15 minutes early for your first appointment.

Please understand the importance of keeping your appointments. We do have a 48 hour new client/24 hour regular client appointment cancellation policy that is strictly enforced.

Please contact our Client Advocate if you have any questions or need additional information.

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PERSONAL PROFILE

Address:
Please click HERE to download a guide on how to measure your circumferences correctly.
Are you a body builder?
How did you find out about Metabolic Balance®? Recommended by:

Declaration of Consent and Privacy Practice

I concur that my coach provides the following information to Metabolic Balance GmbH& Co.KG:
The aforementioned data is sent to Metabolic Balance GmbH & Co. KG to allow said company to create a nutrition plan as part of the participation of the Metabolic Balance® Program. After the creation of the nutrition plan, Metabolic Balance GmbH & Co. KG will transmit the plan to your personal coach. Thereby your personal coach has access to the above data and nutrition plan to provide comprehensive advice under the Metabolic Balance® nutrition concept to you. Your coach and Metabolic Balance® will use your data solely for the above purposes and will not pass it on to third parties. We need your personal details and health data to be able to fulfill our contractual obligation to create a personalized nutrition plan and provide comprehensive coaching sessions to you. Under Art. 15 of the General Data Protection Regulation (GDPR), you are entitled to ask the contractual parties at any time for full details of the personal data collected about your health and person. In addition, under Art. 17 of the GDPR you are entitled at any time to demand the correction, deletion or suspension of individual items of personal data. Moreover, you are entitled, at any time and without stating a reason, to exercise your right of refusal and to modify your given consent for future purposes, or revoke it entirely. You can send your revocation either by mail or email to your contractual partner (your personal coach, see above). In cases of data privacy violations, the data subject is entitled to lodge a complaint with the competent supervisory authority. The competent supervisory authority for data privacy issues is the data privacy representative of the German Federal State in which our company has its registered headquarters.
I concur that my coach provides the following information to Metabolic Balance GmbH& Co.KG:
Information on health and medical history:
Pregnant?
Allergies?
Medications?
To treat:

Information on food consumption / Eating habits as well as food allergies

I eat everything: Meat, Poultry, Fish, Cheese, Seafood, Soy
I seldom eat (choose each that applies):
I refuse to eat (choose each that applies):
With Metabolic Balance® I anticipate:
How do you evaluate your state of health on a scale of 0 to 10? (0 = very bad to 10 = excellent)

Food Preferences:

Would you be willing to eat mushrooms as your protein for some meals if this would be beneficial for your body?
Are you willing to eat eggs?
Please fast 12 hours before blood drawing - only pure water is allowed, do not eat or drink anything else!

Initial Questionnaire

What are your goals in beginning Metabolic Balance?
Please take a moment to review these important details regarding this program. Once you have read and understood each point, please check the box to initial that you agree to do these requirements.
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Please review the following information about your lab work and check the box to initial that you have read and understand. Your folder contains additional instructions from Ulta Labs for your review.
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Please indicate any present Illnesses/Allergies:
Please click HERE to read our Metabolic Balance Consents and Disclaimers and our Agreement and Release of Liability form. Then, sign below. By signing, you are acknowledging that you have read and accept the terms and conditions.
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