JCF Consult Questionnaire

Please set aside 10-15 minutes to fill out this questionnaire in its entirety. This information is collected and reviewed in order to develop an optimal uniquely customized training and nutritional program for achieving your desired body composition goals.


All information gathered is completely confidential and protected under law. It is important that you complete this questionnaire with as much accuracy as possible in order to get the most out of your program.


Full Name:
Phone:
Email:
D.O.B.:
No.&Street:
City/Town:
Country
Age:
Sex:
Height
Occupation:
Current Weight:

Which program are you starting?



List any health conditions or diseases you have been diagnosed with recently and as far back as birth
List all your current medications (and any medications you have taken in the past 12 months).
List all of your current supplements (vitamins, minerals, herbs, protein).
List all the foods you regularly eat throughout the week (include breakfast, lunch, dinner and any snacks)
Do you have any food allergies or dietary restrictions due to religious beliefs, culture or otherwise? If so, please list all of them below (vegan, no dairy etc.)

Do you smoke? YesNo
Do you use recreational drugs? YesNo
Do you consume alcohol?YesNo

If so how much and how often?
How many hours of sleep each night do you get on average?
How many glasses of water do you consume daily?


What is your current level of physical activity?


How many meals per day are you willing to eat? (4-6 meals per day is recommended)

3 Meals4 Meals5 Meals6 Meals



Do you prefer cooking different meals each day or would you be happy eating the same meals 5-6 days per week?

Have you tried any nutrition or training programs in the past which were successful or unsuccessful? What did you like and dislike about them?

Is there a particular goal you would like to focus on with the JCF program? (weight loss, eating healthier, building muscle, building strength, flexibility, competition preparation, sports etc.)? Be as specific as you’d like.

Are there any obstacles you can foresee which would prevent you from following a customized nutritional plan or training program and achieving your desired results on the JCF program?

How much time per week can you devote to training and exercise? (please be specific with your preferred days and exact times)

Do you have any existing injuries? (muscular, skeletal or nerve damage)

Please specify your preferred training location.
GymOutdoorHome

Other (Specify Below)

Please specify your preferred training and exercise type.
Resistance BandsBodyweightCardiovascularHypertrophyStrengthFlexibilityAbdominal / CoreAerobicHIIT TrainingPlyometricsCircuit TrainingTRX


Please select below the exercise equipment you will have access to: (If you are unsure please leave
blank).

BarbellsDumbbellsSquat RackAb WheelKettlebellsLeg PressMedicine BallSeated RowTreadmillSmith MachineBikeBench PressLat PulldownHack SquatCross TrainerResistance BandsSwiss BallBattle RopesPec DeckCablesBench (adjustable)Pull Up BarDip BarShoulder PressChin Up (assisted)Calf raise (machine)Rope (skipping)Rowing (machine)

Other(Specify below)


Do you have any interest in the diets below?
KetoPaleoVeganLow Carb

Please select the from the macronutrient list below your preferred food choices. Select as many as
you like.

Protein Sources
Protein PowderChicken BreastTurkeyLean MinceTuna (canned)Tuna (fresh)Salmon (canned)Salmon (fresh)Lean PorkFishTofuLean BeefKangaroo meatEggsTurkey MinceChicken Mince


Carbohydrate Sources

Sweet PotatoWhite PotatoBrown RiceWhite RicePasta (wheat)WheatBreadRye BreadOatsCassavaPapayaAppleBlueberriesZucchiniMushroomsMangoMilkYogurtBananaPumpkinBeansGrain WrapCarrotsChickpeasLentilsMandarinPearQuinoaYams


Fats Sources

AlmondsCashewsWalnutsOlivesCheeseCoconut OilOlive Oil


Fiber Sources

Spinach LeavesLettuceArugulaKaleCabbageCeleryBeetrootGreen BeansBroccoliPeasBrussel SproutsAsparagus



Thank you for taking the time to complete this questionnaire, if you have any questions please don't hesitate on contacting us at info@joshcavallo.com