Nutrition consultation request form template
This five-step nutrition consultation form asks the client’s main health goal, how often they exercise, their preferred meal plan and any food allergies, followed by the contact details. Clone it into your Growform account and add a medications step.
What the form asks, step by step
The form gathers the basics a nutritionist covers in the opening minutes of a first session. Clinical history can follow in a separate intake once the client books.
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Step 1: “What is your main health goal?”
Weight loss, muscle, healthy eating or disease management frames the whole plan.
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Step 2: “How often do you exercise?”
Exercise frequency adjusts energy needs and the advice you give on timing.
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Step 3: “What is your preferred meal plan?”
Vegan, vegetarian, pescatarian or omnivore sets the foods you can recommend.
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Step 4: “Do you have any food allergies?”
An allergy answer, including “I’m not sure”, is flagged before any plan is written.
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Step 5: “How shall we contact you?”
Name, email and phone come last.
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After submitting
The thank-you screen can tell clients whether to keep a food log before the first call.
Who it’s for
Nutritionists, dietitians in private practice and wellness coaches use this template to book first consultations from their website. It works as a short nutrition questionnaire covering goals, activity, diet and allergies, so the first session starts with a plan rather than a list of questions. A full nutrition intake form with medical history and medications is best sent after booking. Practitioners focused on weight loss programs can compare the weight loss template.
Why this structure converts
- The health goal is asked first, and it is the reason the client is looking for help.
- “I’m not sure” on the allergy step means nobody guesses on a question that affects their safety.
- Diet style is a single choice, so the first plan respects it from day one.
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Make it yours
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Add a medical conditions step
Clients who choose disease management should be asked which condition. Use conditional logic to show that question only to them.
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Ask which allergies
When the allergy answer is yes, show a text field for the specific foods so nothing is missed before the first plan.
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Offer session types
Add a step asking whether the client prefers in-person or video sessions, which helps you schedule the first appointment.
Send every lead where your team works
Frequently asked questions
What should a nutrition intake form ask?
A first-contact form should ask the goal, activity level, dietary preference and allergies. Medical history, medications and a food log belong in the full intake once the client books.
Is the form suitable for health information?
It asks about goals, habits and whether allergies exist, not medical records. Review the privacy rules that apply to your practice before adding clinical questions.
Can clients book a session after submitting?
Yes. Redirect them to your scheduling page after submission, or send the request to vcita and confirm the slot there.
What happens next?
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Step 1: Clone this form template
Clone this template into your Growform account (create one first if you don’t already have one). -
Step 2: Edit your form
Get creative and adjust your form's theme options, questions or layout in the Growform form builder. -
Step 3: Share or embed your form
Share a link to your form, or embed it in your existing website. Receive new submissions by email or send them to 7,000+ apps via Zapier.
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