Nutrition Consultation Request Form Template

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.

Use this template

Last updated 21 August 2026

Fields in this template

Full Namerequired
Email Addressrequired
Phone Numberrequired
Date of Birthrequired
Height (inches)required
Current Weight (lbs)required
Primary Nutrition Goalrequired
Weight loss · Muscle gain and body composition · Sports performance and fueling · General health and energy · Medical condition management (e.g., diabetes, high cholesterol) · Disordered eating recovery · Gut health and digestion
Dietary Restrictions or Preferences (select all that apply)
Vegetarian · Vegan · Gluten-free · Dairy-free · Kosher · Halal · Nut allergy · Other food allergies · None
Describe Your Current Eating Habitsrequired
Medical Conditions or Medications Affecting Nutrition
Have you worked with a dietitian or nutrition coach before?required
Yes · No

Who uses this template

Registered dietitiansNutrition coachesIntegrative health practitionersGym wellness teamsWeight loss clinicsSports performance centersCorporate wellness providersFunctional medicine practitioners

About this template

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.

15 form ideas you can build with this template

Registered Dietitian New Patient Intake Form

Collects medical history, current eating patterns, and nutrition goals for new patients at a private dietitian practice before the initial appointment.

Sports Nutrition Consultation Request

Gathers sport type, competition schedule, training load, and performance fueling goals from athletes seeking sport-specific nutrition coaching.

Weight Loss Program Nutrition Screening

Pre-screens candidates for a medically supervised weight loss program, collecting BMI baseline, prior diet attempts, and comorbidities that affect program eligibility.

Functional Medicine Nutrition Intake

Collects detailed gut health symptoms, food sensitivity history, and current supplement use for a functional nutrition consultation.

Prenatal Nutrition Consultation Request

Gathers pregnancy trimester, dietary restrictions, nausea or aversion patterns, and prenatal supplement use from expectant mothers seeking pregnancy nutrition guidance.

Plant-Based Diet Transition Consultation

Captures a client's current omnivore dietary pattern, motivation for going plant-based, and concerns about nutrient gaps before a vegan transition coaching session.

Pediatric Nutrition Consultation Intake

Collects a child's age, growth history, food allergies, picky eating patterns, and feeding concerns from parents before a pediatric nutrition appointment.

Pre-Surgery Nutrition Consultation Form

Gathers surgery type, timeline, current nutrition status, and post-operative dietary goals from patients preparing for bariatric or orthopedic surgery.

Eating Disorder Recovery Nutrition Session Request

Provides a compassionate intake for clients with disordered eating history, asking about treatment history, current relationship with food, and goals for the session.

Corporate Wellness Nutrition Coaching Intake

Enrolls employees in a company-sponsored nutrition coaching program, collecting dietary habits, wellness goals, and any dietary accommodations needed.

Marathon and Endurance Athlete Fueling Consultation

Captures current race calendar, fueling strategy, GI issues during training, and performance nutrition goals from endurance athletes seeking race-day coaching.

Type 2 Diabetes Nutrition Management Intake

Collects current blood sugar management approach, carbohydrate habits, medications affecting glucose, and specific dietary questions from clients managing Type 2 diabetes.

Post-Cancer Treatment Nutrition Consultation

Gathers cancer type, treatment completed, current side effects affecting appetite, and recovery nutrition goals from clients rebuilding health after oncology treatment.

Teen Athlete Nutrition Coaching Intake

Collects sport, training schedule, growth status, and current eating habits from teenage athletes and their parents seeking guidance on fueling for youth sports performance.

Menopause and Hormonal Nutrition Consultation

Captures current menopausal symptoms, dietary habits, bone density concerns, and cardiovascular risk factors from women seeking nutrition support through hormonal transition.

What's included

Height, weight, and date of birth for BMI and caloric baseline

Primary goal dropdown covering seven common nutrition objectives

Comprehensive dietary restrictions checkbox covering major allergies and preferences

Open-text current eating habits field for honest daily intake capture

Medical conditions and medications field for clinical context

Prior dietitian experience question to calibrate session depth

Only the fields a first consultation needs, stored where just your account can open them

Instant notification to the practitioner on every new request

How to create a nutrition consultation request form

1
Click 'Use this template' to open the nutrition consultation form pre-built in formformform.
2
Add or remove goal options to match your specialization — for example, add 'Eating disorder recovery' or 'Fertility nutrition' if those are areas you serve.
3
Customize the dietary restrictions list to include any specific allergens or diets relevant to your client base.
4
Set your notification email so you're alerted immediately when a new consultation request arrives.
5
Embed the form on your booking confirmation page or share the direct link with clients who have booked a first appointment.
6
Review the submission before the session and use the eating habits and medical fields to prepare tailored recommendations.

Best practices for your nutrition consultation request form

Frame the eating habits field as judgment-free

clients under-report intake when they feel judged. Use neutral, welcoming placeholder text ('there are no wrong answers') to encourage honest responses.

Make medical fields optional

while the information is valuable, mandatory medical disclosure can deter form completion. Mark these fields as optional and explain why they're helpful.

Ask about prior practitioners

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.

Collect dietary restrictions as a checkbox, not a text field

open-text fields produce inconsistent answers that are hard to scan. A checkbox list covers 90% of cases and is faster for the client.

Use the form as a pre-appointment qualifier

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.

Follow up on incomplete submissions

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.

Frequently asked questions

Is this form suitable for use by registered dietitians with HIPAA obligations?

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.

Can I use this form for ongoing client check-ins, not just initial consultations?

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.

Should I include a food diary or 3-day recall section?

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.

Can clients attach lab results or doctor's notes with their submission?

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.

What if a client discloses a serious eating disorder or clinical condition in the form?

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.

How is this different from a general fitness assessment form?

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.