Nutrition Intake Form Template
A free nutrition intake form for nutrition and health coaches. New clients share goals, eating habits, diet, allergies and lifestyle before the first call.
Customize the pages and design to fit your needs.
About this template
A nutrition questionnaire for new coaching clients that covers goals, a typical day of eating, dietary preferences, allergies, cooking, sleep, stress and movement, with a signature to confirm the answers.
Common uses
- Nutrition coaches and nutritionists
- Health coaches
- Meal planning and wellness programs
Key features
- Goals and a typical day of eating
- Diet, allergies and supplements
- Signature to confirm the answers
What this template asks
What's your full name?
Short Text
What's your email address?
Email
What's your phone number?
Phone
What's your date of birth?
Date
What are your main goals?
Multiple Choice · More energy, Weight change, Better digestion, Eat more whole foods, Build healthy habits, Sports performance, Something else
Describe what you eat on a typical day
Long Text
Do you follow a particular way of eating?
Single Choice · No, Vegetarian, Vegan, Gluten free, Low carb or keto, Something else
Do you have any food allergies or intolerances?
Short Text · Optional
How many meals do you cook at home each week?
Single Choice · 0 to 3, 4 to 7, 8 to 14, Almost all of them
How much water do you drink a day?
Single Choice · Less than 4 glasses, 4 to 7 glasses, 8 or more glasses
How would you rate your stress most days?
Opinion Scale
What medications or supplements do you take?
Long Text · Optional
What has made healthy eating hard for you before?
Long Text · Optional
Sign to confirm your answers
Signature
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Frequently asked questions
What should a nutrition intake form include?
Goals, a typical day of eating, the way the client eats, allergies, cooking habits, water, stress, medications and supplements, and what has made healthy eating hard before.
Does it work for health coaches too?
Yes. Health coaches use it as their intake form. Add questions on sleep or movement if your program covers them.
When should I send it?
Right after a client signs up, so you can read their answers and come prepared to the first call. Add a Calendly or Cal.com question to book that call on the same form.