NC - One off plan - Jake Campus Nutrition

NO PLAN IS DESIGNED TO BE FOLLOWED FOREVER – LETS PROGRESS WITH VARIETY AND A CLEAR DIRECTION. The JCN One Off Plan has been designed to give you a taster of our 12-week Lifestyle Program. Jake Campus Nutrition plans are designed to continuously progress and aim to sustain longterm results – HOWEVER we offer the one off plans to help get you started or if you have been a previous client to keep you progressing from where you left off. We aim to tailor this style of plan to your goals by starting with a nutrition consultation. These styles of plans ( depending on the goal ) will be designed to be followed for a certain time frame and guide progressions – to progress further we recommend doing another plan or signing up to our online services to work with a nutritionist more frequently. Its important to understand – by signing up to a one off plan – this doesn’t include follow ups or ongoing support by a nutritionist – it is a one off plan.

JCN Nutrition Consultation

You are about to begin your Jake Campus Nutrition online consultation.

We are diving in to understand your current diet, exercise, and most importantly GOALS. Our one off plans are not designed to be followed forever but a plan to get you started.

Personal Details

Date*

Age requirements*

I am 18 or over

It is company policy to be over the age of 18 to participate on our online program.

Age

Gender*

Do any of the following apply to you?*

Pregnant
Breast feeding
None of the following

Please only select one option

How long have you been breastfeeding for?*

Name*

First Last

Email - please use the one you signed up with*

Enter Email Confirm Email

Photos showcase a better all-round starting point and great tool for us to design a plan best suited for you.

Please upload your front photo for us*

Please upload your back photo for us*

Height*

Write number only in Cm

Weight*

Address*

City and postal code*

Country*

Phone*

Is this your first time working with us?*

What Jake Campus programme were you on and how long ago?*

Are you doing this programme with anyone else in your house hold?*

Is your partner or flatmate on this journey with you and also following a plan? If so let us know we can work plans in together to make prep in the house hold easier.

What is their name?*

We would greatly appreciate you letting us know how you found out about our services:

How did you find out about this program?*

Medication, Illness, Intolerances & Allergies

We need to dive deep into your current health so we can know all the factors that contribute to your diet. Remember I the terms and conditions we do recommend having a medical checkup. Whether you choose to do so or not is your decision.

Are you allergic or intolerant to any foods?*

Yes
No

Please explain the intolerance or allergy and its affects*

Are you taking any medication or suffer from any illnesses?*

YES
NO

Please explain medication or illness*

Have you ever experienced or currently have an eating disorder?*

Yes
In the past I have
No

Please only select one option

Please describe this in further detail:*

JCN Plan Goals & Limitations

Lets start by understanding the approach you'd like to take to get started then set some goals.

What is your main focus for this plan?*

You can only select ONE option. This will determine your starting journey with us. FATLOSS: We will create a fatloss plan to best kickstart this goal. MUSCLE BUILDING: We will design a plan to best compliment your training and goals. ADAPTING NEW EATING HABITS: We will create a plan based around the changes you'd like to make to your current diet.

What are you hoping to achieve out this plan?*

What are your limitations or barriers to your goals.*

What are you wanting to achieve by adapting your eating habits?

Better choices when eating out
New recipes - getting more creative with healthy meals
Controlling appetite
How to eat better as a family
Create sustainable habits
Consistent eating patterns

Whats your SMART goal?

A smart goal includes all points below. Whilst we are working for a result we also want to create LONGTERM results. So we must be realistic. S:pecific M:easurable A:chievable R:ealistic T:imely You may have to make some short term sacrifices in order to reach you goal but we must keep in mind the long game.

Whats your SMART goal?

A smart goal includes all points below. Whilst we are working for a result we also want to create LONGTERM results. So we must be realistic. S:pecific M:easurable A:chievable R:ealistic T:imely You may have to make some short term sacrifices in order to reach you goal but we must keep in mind the long game.

What other types of diets have you done in the past 5 years? Was the diet successful?

Example; Keto, Low carb, Weight Watchers, Paleo, Shake Meal replacements.

Daily & Physical Activity

We need to understand what type of physical activity you are currently doing or able to get into your day to help us build a plan to achieve your goal.

Do you work full/part time? If so what is your profession?*

What type of physical activity do you enjoy and how often does this fit into your weekly routine?*

How many exercise sessions can you fit in per week?*

Explain your exercise regime; Frequency, time of day, duration and type of exercise you do and enjoy:*

What equipment do you have access too?

Gym membership
Home equipment - Weights
Home equipment - Cardio
Outdoors

Lifestyle Food & Habits

Be honest and let us know everything! Foods you like, dislike, current habits and anything else we should know. The more information the better we can work with to create the best plan for you.

Foods you like?*

Foods you dislike?*

Do you use supplements in your diet?

In our programme some supplements can be great for your diet, is this something you are open too?*

Please tell us what products and when you are using them. If you are not using a protein supplement are you open to introducing one?*

Do you track macronutrients?*

You are not required to do this on our program, however if its something you are currently doing and plan to keep doing we will use this tailor our approach to fit!

How often do you eat out or buy your meals weekly?*

How much alcohol do you consume per week?*

Food Log

To assist you in reaching your goals and to customise the best nutrition plan for you, it is important to know your current eating habits. On the following page please write down everything you eat and drink including the time and quantities. Do not try to change your eating habits during the Three Day Food Log. Helpful Hints • Record what you have eaten as soon as possible after meals. • Preparation: How was the food cooked? Was it baked, grilled, fried or steamed? Was it fresh, frozen or canned? • Portion Size: Indicate how much of each food you eat by using cups, grams, teaspoons, or tablespoons, or a “handful.” • Include the fluids that you drink: List the amounts, types and times that you drink them. • Include the “extras” or condiments you eat: Do you put milk or sugar in coffee or tea? Do you use tomato sauce, mustard or mayonnaise etc. on your meals? • Workouts: Record the time and short explanation of your workouts. • Notes: Make note of how you are feeling throughout the day (e.g. are you hungry, low in energy etc.)

Average Week day

What is your go to Breakfast and what time do you have Breakfast?*

What do you have for a morning snack and what time do you have it?*

Whats a typical lunch and what time do you have it?*

What do you have for a afternoon snack and what time do you have it?*

What is your typical dinner and what time do you usually have it?*

Do you eat anything after dinner? If so what is it?*

Average Weekend diet

Weekends can tend to differ to our weekly diet as we may be out and about, away from home, indulge in eating out or your diet may be the same as your weekday.

Please explain your weekend diet and eating times for us:

Please read carefully before proceeding to the next step of your application.

I agree and understand the terms and conditions stated below*

Please read the following and tick before proceeding to payment. We recommend all clients have a medical checkup prior to starting their nutrition program – By accepting the terms and conditions below you understand it is your responsibility whether or not you choose to have this checkup and that any health issues or mental illnesses prior or throughout your program must be shared with Jake Campus Nutrition. You understand that the team at Jake Campus Nutrition are not medical physicians, they consult and recommend nutrition services only. If you have any future queries or concerns regarding your meal plans or health you will inform the team at Jake Campus Nutrition immediately. For medical advice you know to seek your doctor for further assessment and share these results with your nutritionist. Your Jake Campus Nutrition plan has been customised to you and your lifestyle. By accepting the terms you agree not to share or sell to anyone else. Questions or concerns are to be emailed to [email protected] and NOT shared to any social media platforms. By ticking this box you understand that any slander of Jake Campus Nutrition on Social Media can cause defamation to the company. All JCN online programs are for ages 18+by ticking below you consent you are 18 or over. If you seek nutritional advice and you are under the age of 18 you must contact our customer support team to discuss out options.

Now we have your details, lastly we need your payment then our team will create a Nutrition plan for you. The plan can take upto 5 business days and will be delivered by email.

One-off nutrition plan - no charge