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Nutrition client intake form template

Eating habits, health goals and diet before a nutrition consult. It asks for name, email, phone and date of birth, plus 27 more questions. Use this free form template as it is, or change any question, the style and the thank-you screen, then share it or put it on your site.

FreeClient onboardingIntake31 questions6 pages
Style
  • PaperClean and quiet
  • MidnightDark and calm
  • CoralWarm and bold
  • GroveNatural and calm
  • EditorialBig type, few lines
  • TerminalCode on black
  • BubblegumPlayful and round
  • TideFresh and light
  • PosterLoud and graphic
  • GildedBlack and gold
  • LilacSoft and friendly
  • ClayEarthy and warm
  • StudioShapes and primary colors
  • HarborTrusted and clear
  • MintBright and easy
  • RetroChunky and sunny
  • NoirDark and elegant
  • SunriseGolden and upbeat

Nutrition client intake

Nutrition intake

About 8 minutes. Your dietitian reads this before your first session.

6 pages

Page 1

About you

Best way to reach you

Page 2

Your diet

Diet you follow

Meals you cook at home each week

Meals you eat out or order in each week

Water most days

Page 3

Activity

How active are you most days?

Exercise you do

Sleep most nights

How is your energy most days?

Very lowVery high

How stressed do you feel most days?

Not at allVery
Page 4

Health

Do any of these apply to you?

Did a doctor refer you to us?

Page 5

Goals

Main goals

What gets in the way most?

How ready do you feel to make changes?

Not yetVery ready
Page 6

Your first session

How would you like to meet?

We'll use your details to reply and may email you about related products. You can unsubscribe at any time.

Styles

One form, 18 looks.
Pick one, or bring your color.

Customize in minutes

Make it yours.
No code.

Change any question, add your own from 26 question types, and show each one only when it matters.

  • Short text
  • Long text
  • Email
  • Phone
  • Website
  • Number
  • Money
  • Pick one
  • Pick many
  • Dropdown
  • Yes or no
  • Checkbox
  • Stars
  • NPS 0–10
  • Opinion scale
  • Ranking
  • Matrix
  • Date
  • Time
  • Date range
  • Full name
  • Address
  • File upload
  • Signature
  • Statement
  • Hidden

Show-if logic

Ask the next question only when an earlier answer calls for it.

Pages and progress

Split long forms into pages with a progress bar.

Scores and results

Turn answers into a score and show each person what it means.

Files and signatures

Take uploads up to 10 MB and signatures drawn on any screen.

Booking

Open your calendar on the thank-you screen, with name and email filled in.

Consent by region

An opt-in box where the law asks for one, a short notice everywhere else.

Every answer a contact

The company comes from the work email, the campaign from the link.

Spam stays out

A hidden trap, rate limits and temporary emails refused.

Connect to any app

Answers go where you work.
Live in a minute.

  1. 01

    Use the form template

    It opens in Claritia ready to go, in the style you picked. Answers are linked to your contact fields and the form goes live.

  2. 02

    Connect your tools

    Send answers to HubSpot, Salesforce or Omniscient, open your calendar after a booking form, and tell your team in Slack.

  3. 03

    Share it anywhere

    Send the link, or add one line to Webflow, WordPress, Framer or any page. Every answer lands as a contact.

  • HubSpot
  • Salesforce
  • Omniscient
  • Pipedrive
  • Attio
  • Slack
  • Gmail
  • Outlook
  • Calendly
  • Zoom
  • Google Meet
  • Stripe
  • Zapier
  • Webflow
  • WordPress
  • Framer

Frequently asked questions

Something else? hello@tryclaritia.com

Can I customize the nutrition client intake form?

Yes. Add, remove and reorder questions, change the wording and options, and set which ones are required. Pick one of 18 styles or your own color. Tailor can also rewrite the wording for your business from one sentence.

What does the nutrition client intake form collect?

It asks for name, email, phone, date of birth, diet you follow and water most days, plus 25 more questions. You can add or remove any of them.

Is the nutrition client intake form mobile-friendly?

Yes. Every form fits phones, tablets and computers, and works with a keyboard and screen readers.

Is the nutrition client intake form template free?

Yes. Every form template is free on every plan, including the free one. Use it, change it and share it as often as you like.

Where do the answers go?

Each answer is saved in Claritia with the page and campaign the visitor came from. From there it can sync to HubSpot, Salesforce or Omniscient.

How do I put it on my website?

Share the link, or paste one line of code where the form should show. It fits any website, including Webflow, WordPress, Framer and plain HTML.

Can it collect health information?

This form asks for health details, so it stays a draft until your workspace confirms a signed business associate agreement (BAA) with us.

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