Nutrition Intake Form: Free Template and Guide for 2026

A nutrition intake form is the questionnaire a new client completes before your first session, so you arrive knowing their goals, health background, food allergies, eating pattern, schedule, budget and how they want progress measured. Below is a free, copyable template with ten sections written for nutrition coaches, followed by the reasoning behind each section, the red flags that mean a client needs a doctor or registered dietitian first, a filled example for a fictional client, and a comparison of the ways to send, sign and store it.

You can paste the template into a Word file, a Google Form or your practice software. If you run your practice in Coachful, the same questions are sent as intake questions when a client books, the coaching agreement is signed before the first call, and the answers live on the client record next to their check-ins, habits, nutrition targets and invoices. We make Coachful, so read the comparison table with that in mind; it also lists the plain-file and form-builder routes honestly.

What is in this nutrition intake form template?

The template has ten sections: contact details, goals, health background and clearance, allergies and avoidances, relationship with food, current eating pattern, lifestyle, kitchen and budget, tracking preferences, and a scope acknowledgement with signature. Replace every [bracketed] item with your own details and delete any question you will not actually use.

It is written for non-clinical nutrition coaching: habit change, meal structure, food quality, energy and performance. It is not a medical history form and it does not replace the assessment a registered dietitian does for medical nutrition therapy.

[Your business name] Nutrition Coaching Intake Form

Thank you for booking with [Your name]. This form takes about 15 minutes. Your answers help me plan our first session around your real life, not a generic diet. Answer as much or as little as you are comfortable with; you can write "prefer to discuss" for any question. Your answers are stored in [where you store records] and seen only by [you / you and your named team members].

Section 1. About you

1. Full name, and the name you would like me to use.
2. Pronouns (optional).
3. Email and mobile number.
4. Date of birth. (I work with adults aged 18 and over.)
5. Country and time zone.
6. Best way to reach you between sessions: [in-app messages / email / text].
7. Emergency contact name and phone number (used only if you are unwell during a live session).

Section 2. What brought you here

1. In your own words, what would you like to change about how you eat?
2. If our [12]-week program goes well, what will be different in your day? Describe a normal Tuesday.
3. Why now? Is something happening (a new job, a training goal, a family change, a recent check-up) that makes this the right time?
4. What have you already tried (apps, plans, programs, other coaches)? What worked, even briefly, and what made you stop?
5. On a scale of 1 to 10, how ready do you feel to change one habit this week?
6. Which of these matter most to you? Pick up to three: more energy, steadier hunger, cooking more at home, eating more plants, performance in training, digestion comfort, a calmer relationship with food, body composition, feeding my family better, [other].

Section 3. Health background and clearance

I am a nutrition coach, not a doctor or registered dietitian. I ask these questions so I know when your care needs to include a clinician. I do not diagnose or treat medical conditions.

1. Have you been diagnosed with any of the following? Tick all that apply: type 1 or type 2 diabetes, prediabetes, kidney disease, liver disease, heart disease or high blood pressure, high cholesterol, thyroid condition, celiac disease, IBS, Crohn's disease or ulcerative colitis, PCOS, gout, cancer (current or in the past five years), osteoporosis, other: [ ].
2. Are you pregnant, breastfeeding, or trying to conceive?
3. List any prescription medicines you take, including insulin, blood thinners, diuretics, blood pressure or thyroid medicines, and any weight-loss medicines such as GLP-1 injections.
4. List any supplements, protein powders, herbal products or meal replacements you use, and the dose if you know it.
5. Have you had surgery, a hospital stay, or a major illness in the past 12 months? If yes, what and when?
6. Has your weight changed by more than [5 kg / 10 lb] in the past six months without you trying?
7. Are you currently working with a doctor, registered dietitian, therapist or other health professional? If yes, may I coordinate with them with your written permission? [Yes / No / Discuss]
8. Has a clinician given you a specific diet to follow (for example low sodium, low potassium, carbohydrate counting, low FODMAP)? Please describe it.
9. Has a clinician told you to avoid any type of exercise or food change?

Section 4. Allergies, intolerances and food choices

1. Food allergies: list each food and what happens when you eat it. Do you carry an epinephrine auto-injector?
2. Intolerances or foods that upset your stomach (for example lactose, specific vegetables, high-fat meals).
3. Do you follow a cultural, religious or ethical eating pattern I should plan around (for example halal, kosher, vegetarian, vegan, Ramadan or Lent fasting)?
4. Foods you love and want to keep.
5. Foods you will not eat under any circumstances.

Section 5. Your relationship with food

There are no right answers here. These questions help me coach in a way that feels safe for you.

1. How would you describe your relationship with food right now? [Relaxed / Mostly fine / Complicated / Stressful / Prefer to discuss]
2. Have you ever been diagnosed with, or treated for, an eating disorder or disordered eating? [Yes / No / Prefer to discuss privately]
3. Do you ever feel out of control around food, skip meals to make up for eating, or make yourself sick after eating?
4. How do you feel about tracking? Pick one: I like numbers (calories or macros), I prefer portions and plate guides, I prefer no tracking at all, not sure.
5. Would you like us to discuss body weight? [Yes, I want to track it / Only if I bring it up / No, please leave it out]

Section 6. How you eat now

1. Describe yesterday from waking to bed: what you ate and drank, roughly when, and where (home, desk, car, restaurant).
2. Is a weekend day very different? How?
3. How many meals and snacks do you usually eat? When are you hungriest?
4. How often do you eat takeaway, delivery or restaurant meals in a typical week?
5. How much water, coffee, tea, energy drinks and soft drinks do you have on a normal day?
6. How many alcoholic drinks do you have in a typical week?
7. Who decides what is eaten at home, and who cooks?

Section 7. Lifestyle

1. Work pattern: [office hours / shifts / nights / irregular / at home with children / student / retired].
2. How many hours do you sleep on a typical night, and how rested do you feel (1 to 10)?
3. What movement or training do you do in a normal week? Any sport or event you are preparing for?
4. Stress level in the past month (1 to 10). What tends to happen to your eating when stress is high?
5. How often do you travel, and what does eating look like on those days?

Section 8. Kitchen, time and budget

1. Cooking confidence: [I avoid it / basics only / comfortable / I love it].
2. Time you can realistically give to cooking on a weekday: [under 15 minutes / 15 to 30 / 30 to 60 / more].
3. Equipment you have: [oven, hob, microwave, air fryer, slow cooker, blender, freezer space].
4. Weekly grocery budget for your household, roughly: [amount and currency].
5. Who else eats with you (adults, children, ages)? Do any of them have allergies or dietary needs?
6. Where do you usually shop? Any limits on access to fresh food?

Section 9. Check-ins and tracking

1. Which day suits a weekly check-in? [Day]
2. Are you willing to share meal photos? [Yes / Sometimes / No]
3. Progress photos and body measurements are optional and private. Would you like to use them? [Yes / Not yet / No]
4. What would make you stop answering check-ins? Tell me now so we can plan around it.
5. Anything else you want me to know before we start?

Section 10. Acknowledgement and consent

• [ ] I understand that nutrition coaching is education and behaviour support. It is not medical care, diagnosis, treatment or medical nutrition therapy, and it does not replace advice from my doctor or a registered dietitian.
• [ ] I will tell [Your name] if my health, medicines or pregnancy status change during coaching.
• [ ] If I have ticked a condition in Section 3, I understand I may be asked for written clearance from my clinician before we set nutrition targets.
• [ ] I agree that my answers can be stored in [system name] and used only to deliver my coaching. I can ask for a copy or for deletion at [contact email].
• [ ] I confirm the information above is accurate to the best of my knowledge.

Signature: [ ]   Date: [ ]   Printed name: [ ]

Why does each section of the nutrition intake form matter?

Each section answers one coaching decision you have to make in the first two weeks: whether you can work with this person, what to change first, and how to measure it. The table shows what each section is for and what to watch for in the answers.

If you want to compare this structure with a broader version, the health coaching intake form template covers eight sections for general wellbeing clients, and the list of coaching intake form questions explains how to phrase open questions that people actually answer.

What must nutrition coaches add for scope, safety and data?

Nutrition coaches need four things that a general coaching intake form leaves out: a clear scope line, a list of red flags that trigger clearance or referral, a plan for handling health data, and a check of the rules where you and your clients live. None of these are optional extras.

Scope of practice

In many countries and US states, giving individualized nutrition advice to treat a medical condition is regulated, and in some places it is limited to licensed dietitians or other licensed clinicians. Medical nutrition therapy, the use of nutrition to treat a diagnosed condition, is the work of registered dietitians and physicians; the overview of medical nutrition therapy describes it as part of clinical care. A nutrition coach works on habits, food choices, structure and consistency for generally healthy adults, or alongside a clinician who is managing the medical side. Your credential, your country or state and the client's location all affect where that line sits, so check with your licensing board or a local professional body before you write the scope paragraph in Section 3. The guide on how to become a nutrition coach covers scope in more depth.

Red flags that need a clinician first

Decide in advance what you will do when an answer shows a risk. Writing it down means you respond the same way every time, rather than improvising on a discovery call.

The same "screen, then clear" logic applies to exercise. If you also programme training, the article on the PAR-Q form explains how coaches use the official readiness questionnaire without copying it into their own documents.

Sensitive health data

A nutrition intake form collects health information, which carries extra protection in most privacy laws. Under the EU General Data Protection Regulation, data concerning health is a special category that needs explicit consent or another listed legal basis (see the GDPR text, Article 9). In the United States, HIPAA applies to covered entities such as health plans and most providers who bill insurance, and to their business associates; the HHS HIPAA pages explain who is covered. Many independent coaches are not covered entities, but if you are a licensed clinician, or you work under one, the rules can apply to you.

Practical rules: collect only what you will use, tell the client where it is stored, limit who can see it, and delete it when the coaching relationship ends plus whatever retention period you have set. Coachful is not HIPAA-certified and does not sign a business associate agreement, so clinical records, diagnoses and insurance billing belong in a clinical system, not in a coaching platform.

Local law and your agreement

Consumer law, cancellation rights, age of consent and record-keeping rules differ by country and state. The intake form is not your contract. Pair it with a coaching agreement that covers fees, cancellation, scope and refunds, and have a local lawyer review that agreement once. The coaching contracts page shows how agreements are sent and signed in Coachful.

What does a completed nutrition intake form look like?

Here is a filled example for a fictional client, shortened to the answers that shape the first session. Everything in it is invented for illustration.

Example only: fictional client "Maya R.", 41, project manager, UK (GMT)

Goal in her words: "Stop living on coffee until 2 pm and then eating everything in sight after work." A good Tuesday in 12 weeks: breakfast before the school run, a proper lunch, no crisps on the drive home.

Why now: Started a new role with longer commutes; energy is low by mid-afternoon. Tried a calorie-counting app twice, stopped after two weeks both times because logging felt like homework.

Readiness: 7 out of 10. Priorities: more energy, steadier hunger, feeding my family better.

Health: No diagnosed conditions. Not pregnant. Takes levothyroxine for an underactive thyroid (ticked "thyroid condition"). Vitamin D in winter. No surgery in the past year. Weight stable. Sees her GP once a year.

Allergies and choices: No allergies. Lactose makes her bloated. Does not eat pork. Loves curries and bread.

Relationship with food: "Mostly fine." No eating disorder history. Prefers portions and plate guides over numbers. Weight: "only if I bring it up."

How she eats now: Two coffees before noon, often no breakfast. Meal-deal sandwich at 2 pm. Crisps or biscuits in the car at 6 pm. Family dinner at 7.30 pm, usually pasta or a curry. Takeaway twice a week. About four glasses of wine a week.

Lifestyle: Office three days, home two. Sleeps 6 hours, rested 4 out of 10. Walks the dog daily, no other training. Stress 8 out of 10.

Kitchen and budget: Comfortable cook, 20 minutes on weekdays. Has an air fryer and a freezer. Budget roughly [£120] a week for a family of four; children aged 9 and 12, no allergies.

Check-ins: Sundays. Meal photos "sometimes." No progress photos yet. "I stop answering when I feel I've failed the week."

What the coach does with it: no clearance needed for a habit-focused plan, but the coach notes the thyroid medicine and avoids any advice about when to take it, since timing around food is a question for her GP or pharmacist. The first habit targets the 2 pm gap with a ten-minute breakfast option she can make with lactose-free yoghurt, because that is what drives the 6 pm snacking. No calorie targets, no weigh-ins. The check-in is framed around "what got in the way" so a hard week does not end the coaching. That last answer, about failing the week, is worth more than any number on the form.

How can you send and store a nutrition intake form?

You can send the form as a file, as an online form, through an e-signature tool, or inside practice software that keeps it on the client record. The deciding question is whether the answers end up where you will see them before every session, or in an inbox you will not reopen.

A file or Google Form is fine for your first few clients. Once you are coaching more than a handful of people, the cost is time: copying answers into notes, chasing signatures, and searching for a client's allergy list before a session. For a ranked look at form software for this niche, see intake form software for nutrition coaches.

What about other practice tools nutrition coaches use?

Two other tools come up often when nutrition coaches look for intake forms: Practice Better and Dubsado. Both handle forms; they differ in what else they cover.

Practice Better is practice management for wellness and nutrition practitioners, with scheduling, telehealth, charting, billing, programs and a client portal. As listed in October 2026, its free Sprout plan covers 3 clients, and paid plans start with Starter at $35/mo ($25/mo annual) for 10 clients. Its notes say evergreen programs, portal branding, a custom URL and SMS start on the Plus plan at $99/mo, and it does not include a website builder or funnel pages. Practitioners who need charting are its natural fit.

Dubsado is a client workflow CRM with forms, contracts, invoices, a scheduler and automated workflows. As listed in October 2026, Starter is $35/mo ($27.92/mo annual) with one active lead-capture form and no scheduler or automations; Premier is $55/mo ($43.75/mo annual). Dubsado says it does not include website building and is not an email marketing platform, and it has no courses, client community, habits or check-ins, so the coaching itself happens elsewhere.

HoneyBook sits in a similar CRM category, with proposals, contracts, invoices and lead forms, and no programs, habits or check-ins. If your nutrition practice also runs training clients, the personal training client intake form covers the exercise side.

How do you run the nutrition intake form in Coachful?

In Coachful the intake form is one step in a client journey that runs from booking to the first check-in. The client answers intake questions when they book, signs the coaching agreement before the first call, and then sees their program, habits and check-ins in your branded app. You see all of it on one client record.

Coachful is a coaching platform where one subscription covers booking, payments, contracts, program delivery with habits and check-ins, courses, a community, a website with funnels and email, and an AI assistant. It is built for coaches who deliver programs, not only sessions, including solo nutrition coaches growing into a small team and coaches replacing four to six separate tools. It does not do clinical record-keeping or insurance billing, is not HIPAA-certified, has no PayPal and has no Garmin, Fitbit, Whoop or Oura sync. To start, take a free trial and ask for the free white-glove build described below.

This short walkthrough shows the intake flow from the coach's side:

Step 1. Put the intake questions on your booking page

Add the template's sections as intake questions on the session type a new client books, usually a discovery call or a first consultation. Booking pages handle availability rules, buffers, minimum notice and time-zone detection, and sync both ways with Google, Apple/iCloud and Outlook calendars. Sessions can run on built-in video or auto-created Zoom, Meet or Teams links. If the first session is paid, the client pays through your own Stripe Connect or Razorpay account at booking.

The Intakes page shows every intake call, upcoming and converted, so you can see who booked, what they answered and who became a client. If you want to start from a generated draft, the intake form generator turns your niche and offer into questions you can paste in, and intake form scoring explains how to flag answers that need a call.

Step 2. Send the coaching agreement before the first call

Coaching agreements with e-signature are sent before the first call and stored on the client record. Put your scope paragraph, cancellation terms and data-use wording in the agreement, and keep the acknowledgement ticks in Section 10 of the form as a plain-language summary.

Step 3. Read the answers on the client record

The client record holds goals, check-ins, habits, notes, intake answers, tags, payments and sessions, with an AI briefing per client and a status of thriving, active, quiet or at risk. Tag allergies and clearance status (for example "allergy: peanut" or "clearance: received") so they are visible every time you open the client. Michelle, the built-in AI assistant, works from live practice data and briefs you before sessions.

Step 4. Turn answers into targets, meal plans and check-ins

The Fitness & Nutrition pack adds nutrition targets up to calories and macros, meal plans, recipes, food lookup and barcode scanning, private progress photos and measurements, and weekly check-ins. Use the intake answers to choose which of these each client sees. A client who chose "no tracking" in Section 5 gets habits and a plate guide, not macro targets; a client who said "no" to progress photos never gets that prompt. More detail is on the fitness and nutrition page.

Morning and evening check-ins, set up from the coaching flows library, can ask about the exact barrier the client named, such as "Did you eat before 11 am today?" for the example client above.

Step 5. Build habits and a program from the goal

Multi-week programs carry weekly goals, daily tasks, habits, goals with progress bars and streaks. A 12-week nutrition program can start with the one habit the intake pointed to and add a new one each fortnight. When a client enrols, a cohort group is created automatically if you run the program as a group.

Step 6. What the client sees

The client uses one app with your branding inside the Coachful app. They see their next session, any work due before it, their program, habits, check-ins and documents. They do not need a separate login for forms, signatures and payments.

Step 7. Invoices and records

Each payment creates an invoice, and you can raise manual invoices too. Coachful takes a 0% platform fee; only Stripe or Razorpay processing applies. When a client leaves, a full client data export as a ZIP includes the roster, notes, check-ins, goals, habits, sessions and form responses, which helps you honour deletion and access requests.

Current plans: (Lite: $29/month for up to 5 clients; Solo: $49/month for up to 20 clients; Pro: $99/month with unlimited clients; Studio: $199/month with unlimited clients). Lower plans cap the number of clients, Pro is unlimited, and monthly plans cancel in one click.

Can someone set up the intake flow for you?

Yes. Coachful's team will build a form, worksheet, program, funnel or website inside your account at no extra cost, usually within about 24 hours of your request.

Why Coachful stands out: a free white-glove service. From Create > We'll build it for you · FREE, you describe what you want built, for example "this nutrition intake form as booking questions, plus a 12-week habit program with Sunday check-ins," and attach up to 8 reference links and up to 10 files such as your logo, brand guide or the Word version of your form. The team builds it in your own account. Nothing is invented: no fake credentials, testimonials or prices, and any gaps are left for you to fill. It does not include recording videos, logo design, ad management or ongoing marketing. One recent build gave a menopause and midlife health coach starting from nothing a five-page site in sage and cream, with every button leading to a free 20-minute consultation. Read more about the free white-glove service.

What are the most common nutrition intake form mistakes?

Most problems come from asking too much, asking the wrong things, or collecting answers nobody reads. These are the ones that cost nutrition coaches clients or create risk.

• Asking for a seven-day food diary before the first session. Many people abandon it. One described day plus a weekend comparison, as in Section 6, gives you enough to start.
• Collecting medical detail you are not qualified to use. Lab results, full medical histories and medicine doses invite advice outside your scope. Ask what you need to decide whether to refer, and no more.
• Mixing allergies with preferences. A single "foods you avoid" box hides the one answer that matters most. Keep allergies separate and ask what happens when they eat the food.
• Assuming everyone wants numbers. Forcing calories or weigh-ins on someone who opted out damages trust and can harm clients with a difficult food history.
• No scope line. Without a plain statement that coaching is not medical care, clients may assume you are managing their condition.
• Treating ticks as a contract. The form records information; the signed agreement records the terms. You need both.
• Answers stuck in email. If you cannot see the allergy list during a session, the form has not done its job. Store answers where you coach.
• Never updating it. Ask clients to update Section 3 when anything changes, and re-check it at each program renewal.

For more general setup advice, see how to create a coaching intake form and the client onboarding form guide.

Is this template legal, medical or financial advice?

No. This template and guide are general information for nutrition coaches, not legal, medical or financial advice. Rules on nutrition practice, health data, consumer contracts and record-keeping vary by country and state.

Ask a local lawyer to review your coaching agreement and the consent and data wording in Section 10 before you use them, especially if you coach clients in more than one country. Ask a registered dietitian or physician to review the health questions and red-flag rules if you work with clients who have medical conditions, and refer any client whose answers fall outside your scope. If you are a licensed clinician, your professional body's record-keeping rules apply on top of anything here.

Nutrition intake form FAQ

What should a nutrition intake form include?

At minimum: contact details, goals in the client's own words, health conditions and medicines, allergies and intolerances, relationship with food, current eating pattern, lifestyle, cooking time and budget, tracking preferences, and a signed scope acknowledgement. The template above covers all ten in about 55 questions.

Is a nutrition intake form the same as a dietary intake form?

People use the terms interchangeably. In clinical settings a dietary intake assessment can mean a detailed food record or 24-hour recall done by a dietitian. For coaching, the dietary part is Section 6, and the rest of the form covers goals, safety and logistics.

How long should the form be?

Aim for 15 to 20 minutes to complete. If clients regularly stop halfway, cut Sections 7 and 8 down and ask those questions on the first call instead. Keep Sections 3, 4 and 10 complete because they carry the safety and consent information.

Can a nutrition coach work with a client who has diabetes?

Often yes, as habit and behaviour support alongside their medical team, but not as the person managing the condition. Get written clearance, stay within the plan their clinician set, and check your local rules, because in some places individualized advice for a medical condition is limited to licensed professionals.

What do I do if a client discloses an eating disorder history?

Call them before setting any targets, thank them for telling you, and ask whether they have a treating clinician. If symptoms are current or recent, refer to a specialist team. Coach only if their clinician agrees and you have the training, and drop numbers-based tracking.

Where should I store completed intake forms?

Store them where you coach, with access limited to you and named team members, and tell clients where that is. Coachful keeps intake answers on the client record, but it is not HIPAA-certified, so clinical records belong in a clinical system.

Do I need clients to sign the intake form?

A signature or recorded acknowledgement on the scope and consent section is good practice. Your terms belong in a separate coaching agreement, which in Coachful is signed electronically before the first call.

Can Coachful build my intake form for me?

Yes. The white-glove build service is free on every plan: request it from Create > We'll build it for you, attach your existing form, and the team builds it in your account, usually within about 24 hours. Nothing is invented, so you review and fill any gaps.

How often should clients update the form?

Ask them to tell you as soon as their health, medicines or pregnancy status change, and re-check Sections 3 and 4 at each program renewal or every three months, whichever comes first.

Can I use this template for group nutrition programs?

Yes. Keep Sections 1 to 5 and 10 for every participant, shorten Sections 6 to 9, and screen red-flag answers individually before anyone joins the group. Group calls and cohort communities are covered on the group coaching software page.