Assess a client's eating habits, goals, and dietary restrictions.

Full name

Email address

What are your main health or nutrition goals?

Do you have any food allergies or intolerances?

Do you follow any specific diet?

How many meals do you typically eat per day?

How would you rate your current diet?

Any additional notes about your eating habits?

A nutrition and diet assessment form for dietitians, nutritionists, and health coaches working with new clients. It captures health and nutrition goals, food allergies or intolerances, dietary approach, eating frequency, and a self-assessment of current diet quality. This baseline makes it possible to design a nutrition plan that's practical and realistic for each client.

Nutrition / Diet Assessment Form Template

Questions included

Use this template