Nutrition Intake Form Template

A nutrition intake form is a structured questionnaire completed by a new client before their first session with a dietitian or nutrition coach. It gathers primary nutrition goals, current eating habits, food allergies and intolerances, dietary restrictions, relevant health conditions, weight self-assessment, and foods the client dislikes or refuses, providing a complete dietary profile in one document.

Clients should complete the nutrition intake form before the first consultation, ideally at least 24 hours in advance. This gives the dietitian or nutrition coach time to review allergy and health-condition disclosures, flag any items that may require physician coordination, and arrive at the first session with questions tailored to the client's specific goals and restrictions.

A thorough nutrition intake form includes checkboxes for vegetarian, vegan, gluten-free, dairy-free, halal, and kosher patterns, plus an other option for less common restrictions. Covering religious, ethical, and medical dietary needs in a single field prevents the practitioner from inadvertently recommending foods the client cannot or will not eat, protecting both rapport and adherence.

When clients list foods they dislike or refuse, practitioners can design meal plans that never rely on those items for key nutrients, removing a common reason clients abandon dietary guidance. Identifying substitution needs early, such as a client who dislikes fish but needs omega-3 intake, allows the coach to source alternative foods before the first plan is delivered.

Yes. A nutrition intake form with a primary-goal radio option for managing a health condition and a freetext field for relevant health conditions allows clients with diabetes, hypertension, celiac disease, or other diagnoses to disclose clinical context upfront. Practitioners can then coordinate with the client's medical team and apply evidence-based dietary guidelines specific to that condition from the first session.