Client Intake Form Template for Nutrition Coaching

Use in FirstRep form

Personal Information

Gathering personal details is crucial for tailoring nutrition plans.

Aa Full Name *

John Doe

# Age *

Aa Email Address *

[email protected]

Aa Phone Number

123-456-7890

Health History

Understanding health history helps in creating safe nutrition plans.

Y/N Do you have any allergies? *

... Please list any medical conditions.

e.g., diabetes, hypertension

... Current medications

List any medications you are taking

Dietary Preferences

Identifying preferences ensures meal plans are enjoyable and effective.

v Diet type *

vv Preferred cuisines

... Foods you dislike

List foods you want to avoid

Goals and Challenges

Defining goals and identifying challenges helps in creating realistic plans.

... What are your primary nutrition goals? *

e.g., weight loss, muscle gain

... What challenges do you face with nutrition? *

e.g., time, knowledge, cravings

v How do you currently track your food intake? *

Lifestyle and Preferences

Understanding lifestyle helps in creating a sustainable nutrition plan.

v Activity level *

# Number of meals per day *

Y/N Do you prefer meal prep? *

Additional Notes

Any other information that could help in your nutrition journey.

... Additional information

Anything else we should know?

Why Use This Template

Tailored Nutrition Plans

Collecting detailed information allows for customized meal plans.

Identify Client Needs

Understanding pain points helps in addressing client concerns effectively.

How to Use

Distribute the form to new clients before the first session.

Review the collected data to prepare for the initial consultation.

Customization Tips

Add branding elements like your logo to personalize the form.
Include a short introductory text for each section for clarity.
Modify field labels to resonate with your specific audience.

Build and send nutrition coaching templates digitally with FirstRep. Free for up to 3 clients.

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Frequently Asked Questions

Can I modify the form?

Yes, feel free to customize fields to better fit your coaching style.

How can I ensure client compliance?

Regular follow-ups and support can significantly enhance adherence.