Client Information
Information needed from client before starting program
Client Name:

Client Email:



Home Address;




Phone:


Birth Date:


Sex:


Occupation:




What is your fitness
goals?




Have you ever work
with a diet coach?


If so, who?


Height:



Current Weight:
Email current picture


Goal Weight:



Do you have any food
allergies/dietary
restrictions?




Describe your current
medical and health
status:



Past Medical History,
including major
illness, surgery,
injuries or disabilities
or exercises you
cannot perform



Current Medications:





Schedule: Time you
sleep, wake-up, meal
times, work times,
training time, cardio
time


Meals: what you eat,
including portions and
condiments used at
each meal



Supplements: current
supplements you are
using and what times
and how much (i.e>
500 mg vitamin C 3
times daily)


Current workout
routine: training split,
exercises used for
each body part and
how many sets, reps
and weight used



Cardio: how much,
what kind, heart rate




List of equipment you
do not have access to
Yes
No

I can do all things through Christ which strengtheneth me. Phl 4:13

After your payment and completed form are received, Stephen
will design your selected program and email it to you in 3 to 5
business days.
IFBB Professional Bodybuilder