Help clients articulate exactly what they eat and what they're hoping to change before they ever sit down with your nutritionist. This consultation request form collects health metrics, dietary restrictions, eating habits, and medical context so practitioners can arrive at the first appointment fully prepared.
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A nutrition consultation request form is one of the most important tools in a dietitian's or nutrition coach's intake toolkit. Understanding what a client actually eats — not what they think they should eat — before the first session allows the practitioner to identify patterns, gaps, and priorities rather than spending billable time gathering basic information. The form also surfaces medical context (medications, diagnoses) that directly affects dietary recommendations.
For clients, filling out a detailed intake form before the consultation creates reflective engagement. Describing your eating habits in writing, even imperfectly, often prompts the kind of honest self-assessment that casual conversation doesn't. Practitioners consistently report that clients who complete a thorough intake form arrive at the first session more self-aware and more ready to engage with change.
formformform provides a private, easy-to-share intake experience for nutrition professionals at no cost. Practitioners share a single link via email or on their booking confirmation page. All submissions are securely stored in the dashboard, accessible only to the account holder, and trigger an instant email notification — so the practitioner can review the intake and prepare notes before the consultation begins.
Use your own copy to change labels, remove questions and add the details you need. Try the preview alongside this guide to see what respondents will be asked.
Review the starting questions and choices. You can change them in your own copy.
Morgan Lee
morgan@example.com
(555) 456-7890
65
150
What does a typical day of eating look like? Include meals, snacks, and drinks. Be as honest as possible — there are no wrong answers.
List any diagnosed conditions (e.g., Type 2 diabetes, IBS, thyroid disorder) or medications that affect your metabolism, digestion, or dietary needs.
Suggested uses, and why this starting point can help. Adapt the questions to your own process.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Date of Birth” in particular and adapt it to the detail you need.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Height (inches)” in particular and adapt it to the detail you need.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Current Weight (lbs)” in particular and adapt it to the detail you need.
Replace scattered requests with a consistent starting point. The answers help you understand the work, identify gaps and prepare a follow-up. Review “Primary Nutrition Goal” in particular and adapt it to the detail you need.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Dietary Restrictions or Preferences (select all that apply)” in particular and adapt it to the detail you need.
Gathers sport type, competition schedule, training load, and performance fueling goals from athletes seeking sport-specific nutrition coaching.
Enrolls employees in a company-sponsored nutrition coaching program, collecting dietary habits, wellness goals, and any dietary accommodations needed.
Collects detailed gut health symptoms, food sensitivity history, and current supplement use for a functional nutrition consultation.
Click 'Use this template' to open the nutrition consultation form pre-built in formformform.
Add or remove goal options to match your specialization — for example, add 'Eating disorder recovery' or 'Fertility nutrition' if those are areas you serve.
Customize the dietary restrictions list to include any specific allergens or diets relevant to your client base.
Set your notification email so you're alerted immediately when a new consultation request arrives.
Embed the form on your booking confirmation page or share the direct link with clients who have booked a first appointment.
Review the submission before the session and use the eating habits and medical fields to prepare tailored recommendations.
clients under-report intake when they feel judged. Use neutral, welcoming placeholder text ('there are no wrong answers') to encourage honest responses.
while the information is valuable, mandatory medical disclosure can deter form completion. Mark these fields as optional and explain why they're helpful.
someone who has worked with a dietitian before comes with existing habits, prior recommendations, and potentially frustrations. Knowing this upfront changes your first session approach.
open-text fields produce inconsistent answers that are hard to scan. A checkbox list covers 90% of cases and is faster for the client.
if the submission reveals a medical condition outside your scope of practice, you can refer the client appropriately before the session rather than discovering this in person.
if a client fills out contact info but skips the eating habits section, send a gentle reminder that the full intake helps you prepare a better session.
Collects medical history, current eating patterns, and nutrition goals for new patients at a private dietitian practice before the initial appointment.
Gathers sport type, competition schedule, training load, and performance fueling goals from athletes seeking sport-specific nutrition coaching.
Pre-screens candidates for a medically supervised weight loss program, collecting BMI baseline, prior diet attempts, and comorbidities that affect program eligibility.
Collects detailed gut health symptoms, food sensitivity history, and current supplement use for a functional nutrition consultation.
Gathers pregnancy trimester, dietary restrictions, nausea or aversion patterns, and prenatal supplement use from expectant mothers seeking pregnancy nutrition guidance.
Captures a client's current omnivore dietary pattern, motivation for going plant-based, and concerns about nutrient gaps before a vegan transition coaching session.
Collects a child's age, growth history, food allergies, picky eating patterns, and feeding concerns from parents before a pediatric nutrition appointment.
Gathers surgery type, timeline, current nutrition status, and post-operative dietary goals from patients preparing for bariatric or orthopedic surgery.
Provides a compassionate intake for clients with disordered eating history, asking about treatment history, current relationship with food, and goals for the session.
Enrolls employees in a company-sponsored nutrition coaching program, collecting dietary habits, wellness goals, and any dietary accommodations needed.
Captures current race calendar, fueling strategy, GI issues during training, and performance nutrition goals from endurance athletes seeking race-day coaching.
Collects current blood sugar management approach, carbohydrate habits, medications affecting glucose, and specific dietary questions from clients managing Type 2 diabetes.
Gathers cancer type, treatment completed, current side effects affecting appetite, and recovery nutrition goals from clients rebuilding health after oncology treatment.
Collects sport, training schedule, growth status, and current eating habits from teenage athletes and their parents seeking guidance on fueling for youth sports performance.
Captures current menopausal symptoms, dietary habits, bone density concerns, and cardiovascular risk factors from women seeking nutrition support through hormonal transition.
formformform collects data securely and restricts access to the account holder, but is not a HIPAA Business Associate. If you practice under HIPAA, review whether a standard web form meets your obligations or whether a HIPAA-compliant platform is required for health intake data.
This template is designed for initial intake. For ongoing check-ins, create a shorter follow-up form focused on progress, adherence, and updated goals. Use the same client email to connect the forms for each person.
For a detailed pre-session intake, you can add a long_text field asking clients to complete a 3-day food diary before submission. This is especially useful for dietitians doing formal dietary analysis as part of the consultation.
Clients can attach lab results or a doctor's note straight from their phone — add an Upload field to the intake and it arrives with their submission, up to 2 MB each, plenty for a typical PDF report or a photo of a printed page. Health documentation like this is worth encrypting: it's a per-form setting you switch on before the form goes live, and it locks in place the moment your first response arrives. Once it's on, every upload is encrypted inside the client's own browser before it ever reaches you, so what lands on the server is ciphertext, filename included. Just note on the form that encrypted files run about a third larger, so plan on originals nearer 1.4 MB than the full 2 MB. For anything bigger than that, having clients email it separately and reference their submission date still works as a backup so you can match it to their intake.
Review all submissions before the appointment. If a client discloses a condition outside your scope, reach out before the session to discuss a referral or ensure you have the appropriate qualifications and supervision in place.
A fitness assessment focuses on physical performance, exercise history, and training goals. A nutrition consultation form digs deeper into eating patterns, food relationships, medical dietary needs, and nutritional history — the data a dietitian needs, not a personal trainer.
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