Nutrition consultation request form
A nutrition consultation is a first conversation, not a diagnosis. This form collects what the consultant needs to know before the call — goals, restrictions, preferred format — so the intake happens in the appointment, not in a back-and-forth.
The form beside this text is live. Fill it in and submit it — it validates exactly as it would for a real respondent, and saves nothing.
Checkboxes capture multiple goals at once
A client pursuing sports performance AND general wellness picks both in one question. Radio buttons force a single answer; checkboxes let the form capture the real picture.
Restrictions and medical flags come with the request
A free text field for restrictions lets clients tell you about intolerances, medications, or conditions before the call, so the consultant can sketch a plan rather than doing full intake.
No card required.
Nutrition Consultation Request Form
Live previewHow to build this form
5 steps in the editor. Nothing here needs a paid plan.
- Add short text, email and optional phone fields for the client's contact details.
- Add a checkbox group for the client's goals — weight management, sports performance, medical condition, general wellness. Clients often pick more than one.
- Add an optional long text field for dietary restrictions, allergies or medical conditions to flag in advance.
- Add a dropdown for preferred format — in-person, video or phone consultation.
- Share the form and respond within one business day with time options. The form is not an automatic booking; it is the opening message.
Fields in this form
6 fields, using 6 of the 19 field types available.
| Question | Field type | Required |
|---|---|---|
| Your name | Short text | Yes |
| Yes | ||
| Phone | Phone | Optional |
| What are your goals? (select all that apply) | Checkboxes | Yes |
| Dietary restrictions, allergies, or medical notes | Long text | Optional |
| Preferred consultation format | Dropdown | Yes |
What goes wrong with this form
Specific to a nutrition consultation request form, not general advice about forms.
Providing meal plans or medical advice through the form
A form is an intake tool, not a clinical channel. Answering "what should I eat?" in the responses is practising nutrition without the back-and-forth a real consultation needs. Collect the request, then consult directly.
Requiring the client to write out all restrictions
An optional long text field is enough — clients who have restrictions will fill it. Requir details upfront and you lose the client who does not know how to phrase it or who wants to discuss it on the call.
Making format optional
A dropdown for in-person, video or phone lets you know what equipment and time you need to prepare. Optional format fields mean you schedule one way and the client expected another.
Questions about this form
When do I get a consultation scheduled?
After you submit the form, the nutritionist or dietitian reviews it and calls or emails to confirm a time. The form is the request, not the booking itself, because the consultant needs to hear your goals directly and answer any questions about what to expect.
Do I need to be diagnosed with a medical condition to request a consultation?
No. The form is for weight management, sports performance, general wellness, or a medical referral — pick what applies to you. If a medical condition is at play, mention it in the restrictions field so the consultant prepares.
What do I need to tell the nutritionist before our first call?
Your goals, any restrictions (allergies, medications, food aversions, dietary practices), and your preferred format (in-person, video or phone). Beyond that, the consultation is your chance to ask. If you have lab work or a doctor's note to share, you can email it after scheduling.
Other templates
- Patient intake formInsurance provider and ID as their own fields, so registering doesn't start with a phone call.
- Appointment Request FormCollect a preferred date, time and reason for visit for clinics, salons and studios.
- Medical HistoryCollect a new patient's medical background before the first appointment.