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Information needed from client before starting program
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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
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Yes
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No
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