Built for Australian private practice

Nutrition client intake form

Prepare for a first consultation with prompts for goals, health history, food preferences and daily routines.

Free to use · No signup

Print the blank worksheet or choose Save as PDF in your browser. Complete it offline; no client details are entered on this page.

Notrispace

Nutrition client intake form

Client reference: __________________ Date / week: __________________

Contact and communication

Preferred name, contact method and accessibility or communication needs.

Goals and priorities

What brings you here? What would a useful change look like?

Health background

Relevant conditions, current medicines, supplements and care team.

Food preferences and access

Allergies, preferences, cultural needs, budget and cooking facilities.

Daily routine

Usual meals, work pattern, sleep and activity.

Questions for the consultation

What else should your practitioner know?

Blank worksheet for professional use. Store completed copies securely. · notrispace.com/en/tools

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Manage client records, meal plans and consultation notes in your practice workspace.

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How to use this worksheet

Choose the sections relevant to the consultation, complete the worksheet and agree how it will be reviewed.

Worked example

For example, print a blank copy before an appointment, complete it together and agree a follow-up date.

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Questions practitioners ask

Can I use it without an account?

Yes. View and print the complete worksheet without signup or an email address.

Can I edit or save client details here?

This is a blank printable worksheet. It does not collect, save or send client information. Complete it after printing or in your own PDF editor.

Does this replace professional assessment?

No. Adapt the prompts to your client and scope of practice. It is not a validated screening instrument, diagnostic tool or legal consent form.