About this template
The Nutrition Coaching Intake Form is designed for nutritionists, dietitians, and health coaches to comprehensively assess a new client's baseline health, lifestyle, and dietary habits. Collecting accurate information before the first consultation allows practitioners to design personalized, sustainable nutrition plans tailored to each client's unique physiology and daily routine.
This intake form captures essential details including contact information, occupational background, current health conditions, allergies, medications, and specific fitness or nutrition goals. It also delves into daily habits such as sleep patterns, stress management, caffeine intake, and physical activity levels to ensure a holistic understanding of the client's lifestyle.
Built for seamless digital onboarding, this template eliminates messy paper questionnaires and standardizes your client intake workflow. Practitioners can instantly convert and customize this form using Doc2Form to match their clinic or coaching brand, helping clients kickstart their wellness journey smoothly from any device.
Key features
- Comprehensive health and medical history tracking
- Detailed lifestyle, sleep, and stress habit assessment
- Goal-setting fields for tailored nutrition planning
- Emergency contact and personal demographic collection
- Ready to share instantly via link, email, or website
Use cases
- Initial client consultations for private practice dietitians
- Onboarding participants into structured health and weight-loss programs
- Remote nutrition coaching intake and assessment
- Gym and wellness center nutritional program enrollment
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Select your birth date.
- Gender (Dropdown)Select your gender identity.
- Email Address (Short answer)Where can we send your coaching materials and appointment links?
- Phone Number (Short answer)Enter your best contact number for reminders and updates.
- Home Address (Paragraph)Enter your current residential address.
- Emergency Contact Person (Short answer)Name of a trusted person we can contact in case of an emergency.
- Emergency Contact Phone Number (Short answer)Phone number for your emergency contact.
- Occupation & Work Schedule (Paragraph)Briefly describe your job position, company, and typical daily work hours.
- Current Weight (kg) (Short answer)Enter your current body weight in kilograms.
- Height (cm) (Short answer)Enter your height in centimeters.
- Fitness or Nutrition Goals (Paragraph)What do you primarily hope to achieve through this coaching program?
- Desired Weight (kg) (Short answer)Enter your target weight goal, if applicable.
- Current Health Conditions (Paragraph)List any diagnosed medical conditions (e.g., diabetes, high blood pressure, IBS).
- Allergies & Food Sensitivities (Paragraph)List any food allergies, intolerances, or adverse reactions you experience.
- Current Medications & Supplements (Paragraph)List any prescription medications, over-the-counter drugs, or vitamins you take regularly.
- Smoking Status (Multiple choice)Do you smoke or use tobacco products?
- Alcohol Consumption (Dropdown)How often do you consume alcoholic beverages?
- Nightly Sleep Hours (Short answer)On average, how many hours of sleep do you get per night?
- Stress Management Approach (Paragraph)How would you rate your current daily stress level and how do you manage it?
- Gym Attendance & Exercise (Multiple choice)How often do you engage in physical exercise or sports?
- Dietary Preferences (Checkboxes)Select any categories that apply to your current eating habits.
- Commitment & Expectations (Paragraph)How ready are you to make lasting habit changes, and what do you expect from your coach?
- Client Acknowledgment & Signature (Short answer)Please type your full legal name as an electronic signature to confirm that the information provided is accurate and complete.
- Date Signed (Date)Today's date.
FAQ
How do I share this form with my new clients?
Once your template is generated in Google Forms, simply click the 'Send' button to share the link via email, text, or embed it directly on your website for automated client onboarding.
Can I customize the questions to fit my specific coaching style?
Yes! Because the form lives entirely in your Google Drive, you have full freedom to add, remove, or edit any questions using the standard Google Forms editor.
Is this form mobile-friendly for my clients?
All Google Forms are fully responsive, meaning your clients can comfortably fill out their complete intake questionnaire on their smartphones, tablets, or computers.
How do I collect signatures or agreements?
You can add acknowledgment checkboxes and short text fields to capture digital agreements and timestamps for your coaching terms and policies.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.