Nutrition Intake Form

Make taking on new patients at your nutrition practice a breeze with our free and interactive PDF Nutrition Intake Form designed for dietitians and nutritionists.

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What Is A Nutrition Intake Form

Nutritionists and dietitians see a wide range of clients from many different backgrounds, but one thing all their clients will have in common is completing an intake form at or prior to their first session.

An intake form is a commonly used tool across all areas of healthcare. A patient intake is a routine process conducted prior to or upon a patient’s first visit with a practitioner in order to gather some basic information. This will usually include their name and contact details for record-keeping purposes, but may also include any broad goals they have either for the session or for their health in general.

Our is designed specifically for Registered Dietitians (RDs) and Registered Dietitian Nutritionists (RDNs) to gather information on their new clients upon intake into their practice.

Note, while an intake form may ask some broad questions about the patient’s goals and concerns, it differs from an initial assessment in that it typically does not include as much detailed medical information.

Printable Nutrition Intake Form

Download these nutrition intake forms to capture all the client information required to achieve better outcomes.

How To Use This Template For Nutrition Intake Forms

Our nutrition intake form is designed to save you time and reduce your administrative workload so you can get back to helping your clients. As such, our intake form can be completed by your client independently prior to their first session with you. Just follow these steps to start incorporating this intake form into your nutrition practice.

Step One: Download the Template

The first step is to download a copy of the nutrition intake form. You can access the PDF version of this template from the link on this page, or access the digital version from within Carepatron. 

Step Two: Provide to your Client

It’s up to you when you provide this intake form to your client, but we recommend sending it to your client prior to their first session. This way, you can maximize the time spent in their session with you. Whether you provide a digital or paper copy also depends on how you like to run your practice, but we think keeping things digital is the best way to go for secure sending and storage of confidential information.

Step Three: Store the intake form securely

Once your client has returned the completed intake form to you, the last step is to store the information securely. You, or others in your client’s care team, may require access to the information contained within this form at a later date and so it is important that you store this form securely, but also somewhere that is accessible to others.

Nutrition Intake Form Example (Sample)

To get an understanding of the sorts of things your client might include in this intake form, we have included an example nutrition intake form completed using this template. Your clients may have completely different goals and concerns than those in this sample, but this example can still be helpful to get a general idea of how intake forms should be completed.

Take a look at the example nutrition intake form here: 

Nutrition Intake Form Example (Sample)

Who Can Use this Printable Nutrition Intake Form (PDF)?

There are many different healthcare practitioners who help clients with nutrition or dietary concerns, and the reasons clients seek out nutrition assistance are equally as vast! Some may be struggling with weight loss, while others are battling weight gain. The reasons for their concerns may be unknown, or as specific as a side effect from a particular medical treatment. Children, adults, and the elderly can all have different nutritional needs- and so there are many different specialties within the nutrition and dietitian fields. Luckily, our nutrition intake form can be used by a wide range of practitioners including:

  • Gerontological nutritionists
  • Pediatric nutritionists
  • Clinical dietitians
  • Community dietitians
  • Sports nutritionists
  • Family doctors

And any other practitioners who routinely see patients seeking nutrition or dietary advice.

Why Is This Form Useful For Nutritionists

This intake form is designed to standardize the intake process at your practice and take the hassle out of taking on new patients. Here are just a couple of the reasons why this form is useful for nutritionists or dietitians:

Collect key information 

There is some information you will need to collect for every new patent including their name, contact details, date of birth, and an emergency contact. This form takes the work out of collecting this information as all the fields are already laid out for you in a clearly formatted template.

Save time at your first appointment

Share this intake form with your clients electronically prior to your first session together and better utilize the session time to address your client’s nutrition concerns.

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Benefits of Nutrition Intake Forms Doc

Keep it Digital

One huge benefit of utilizing this template in your practice is the ability to keep it completely digital. Simply securely send the digital version of this intake form to your client prior to their first appointment, and they can complete and return it to you- all without either of you needing a printer! This also has the benefit of improving your practice’s storage and accessibility of your documents to others in your client’s care team.

Collect Insurance Information

Streamline the billing process before your session has even begun by collecting your patient’s insurance information as part of this nutrition intake form. 

Be Prepared for your First Session

The concerns and goals section of this intake form will allow you as the practitioner a head-start on why your client has chosen to see you. You then have the chance to prepare for their session with you, and ultimately provide the best experience and help for your clients.

Improve Collaboration 

Collaborating or transferring patients to other practitioners within your practice is much easier when your client’s intake information is clearly laid out and readable, as in our nutrition intake form template. Reduce the hassle of picking up where others left off by keeping your patient’s information well-organized and pre-formatted. 

Standardize your Practice’s Intake Procedure

Having all practitioners at your practice use the same intake form is a great way to save administration time and ensure everyone who comes to your nutrition practice gets the same attention to detail upon intake.

Commonly asked questions

Is an intake form an assessment?

No, a nutrition assessment is a much more comprehensive process that will need to be completed by an RD or RDN in person to take anthropometric measurements and conduct physical examinations.

What should my clients put as their nutrition/health concerns?

This section is a space for your client to add the reason they have booked a session with you. If applicable, they could be given a pre-warning that administration staff may handle the document and have access to this section- so if they have particularly sensitive concerns, they should feel free to save these concerns for the session with you.

When should my clients complete their intake form?

We recommend this form is completed prior to their first session with you so that the session time can be spent on more important tasks than the administration side of things, however, this is ultimately up to you.

Why Use Carepatron For Nutrition Intake Form Software?

Carepatron is a state-of-the-art suite of software solutions designed to help automate your practice’s administration and save you time.

Carepatron offers a seamless and intuitive experience for managing and automating all aspects of your practice’s administration. 

Offer your clients their own patient portal through which they can access this Nutrition Intake Form. The client portal also allows your clients to book in an in-person or video appointment with you. Reduce no-show appointments with Carepatron’s automated SMS or email appointment reminders, manage your practice’s billing and payments, or even utilize our AI-powered voice-to-text dictation software.

Additionally, you can access this template and a whole range of other templates from Carepatron's community template library. Or create your own frequently used templates and share them with your team members in your Carepatron platform.

Nutrition Intake Form Software
Is an intake form an assessment?
Is an intake form an assessment?
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