Nutrition Consultation Form

Prepare for a first nutrition appointment with the diet history, the medical background, and the goal already written down.

Prepare for a first nutrition appointment with the diet history, the medical background, and the goal already written down.

Full name

Email address

Date of birth

What you want to work on

Main reason for coming

Tell me more about that

What have you tried before?

How you eat now

Walk me through a typical day of eating

How often do you eat out or order in?

Do you follow a particular diet?

Foods you will not eat

Health

Medical conditions

Medication and supplements

Allergies and intolerances

How active are you?

How is your sleep?

Anything else you would like to mention?

Use this template

Opens in the builder. Nothing is saved until you edit it.

Fields: 16 questions
Theme: Forest, switchable in the preview
Updated: 11 August 2026

Ideal for

Nutritionists
Dietitians
Health coaches
Clinics

Best used in

First consultations
Programme design
Health screening

About this template

The single most useful question in nutrition intake is what a typical day of eating actually looks like, and the placeholder here asks for honest rather than ideal on purpose. People describe the diet they intend to have unless you explicitly invite the one they have.

Asking what has been tried before saves a practitioner from recommending the thing that already failed, which is the fastest way to lose a client's confidence. It also tends to reveal the pattern behind repeated attempts, which is usually more useful than the diets themselves.

Activity and sleep are here because neither is a nutrition question and both change the advice. Add a food diary upload if you ask clients to track for a week beforehand, and keep the dislikes field, since a plan containing food someone will not eat is not a plan.

Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.

Fields in this template

Full name*Short text
Email address*Email
Date of birthDate
Main reason for coming*Dropdown
Tell me more about that*Long text
What have you tried before?Long text
Walk me through a typical day of eating*Long text
How often do you eat out or order in?Dropdown
Do you follow a particular diet?Dropdown
Foods you will not eatLong text
Medical conditionsLong text
Medication and supplementsLong text
Allergies and intolerancesLong text
How active are you?Dropdown
How is your sleep?Dropdown
Anything else you would like to mention?Long text

Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.

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Nutrition Consultation Form

Prepare for a first nutrition appointment with the diet history, the medical background, and the goal already written down.

Nutrition Consultation Form

Prepare for a first nutrition appointment with the diet history, the medical background, and the goal already written down.

Full name

Email address

Date of birth

What you want to work on

Main reason for coming

Tell me more about that

What have you tried before?

How you eat now

Walk me through a typical day of eating

How often do you eat out or order in?

Do you follow a particular diet?

Foods you will not eat

Health

Medical conditions

Medication and supplements

Allergies and intolerances

How active are you?

How is your sleep?

Anything else you would like to mention?

Use this template

Opens in the builder. Nothing is saved until you edit it.

Fields: 16 questions
Theme: Forest, switchable in the preview
Updated: 11 August 2026

Ideal for

Nutritionists
Dietitians
Health coaches
Clinics

Best used in

First consultations
Programme design
Health screening

About this template

Fields in this template

Full name*Short text
Email address*Email
Date of birthDate
Main reason for coming*Dropdown
Tell me more about that*Long text
What have you tried before?Long text
Walk me through a typical day of eating*Long text
How often do you eat out or order in?Dropdown
Do you follow a particular diet?Dropdown
Foods you will not eatLong text
Medical conditionsLong text
Medication and supplementsLong text
Allergies and intolerancesLong text
How active are you?Dropdown
How is your sleep?Dropdown
Anything else you would like to mention?Long text

Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.

Related templates

Browse all templates

Personal Training Consultation
About you
Full name
Date of birth
Email address
Phone number
Goals and history
What are you hoping to achieve?
Lose weightBuild strengthImprove endurance
How active are you right now?
Sedentary (little or no exercise)Light (1 to 2 sessions a week)Moderate (3 to 4 sessions a week)
Any injuries, conditions, or medication we should know about?
When are you usually free?
Early morningMiddayEvening
Personal Training Consultation
Sign up new personal training clients, set their exercise goals, and surface any injuries before the first session.
Gym Membership Form
Full name
Date of birth
Email address
Mobile number
Home address
Your membership
Which membership?
Start date
Anything to add?
Locker hireTowel serviceClass pass
What are you here for?
General fitnessStrengthWeight loss
Gym Membership Form
Sign a new member up with the plan, the health declaration, and the emergency contact recorded before their first session.
Personal Training Intake Form
Full name
Email address
Phone number
Date of birth
What you want
Main goal
What does success look like for you?
Is there a date you are working towards?
Training history
How much training have you done?
Personal Training Intake Form
Build a first programme from real information: the training history, the injuries, the schedule, and what the client actually wants.

Nutrition Consultation Form

What you want to work on

How you eat now

Health

Categories

Ideal for

Best used in

About this template

Fields in this template

Related templates

Nutrition Consultation Form

What you want to work on

How you eat now

Health

Categories

Ideal for

Best used in

About this template

Fields in this template

Related templates