Nutrition Intake Form — shared by the community
Clara D. shared this 19-question build with 3 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 19 questions, 2 pages, 3 conditional rules.
- Shared by
- Clara D. · Non-profit programme lead
- Questions
- 19
- Replies
- 10
- Copies taken
- 555
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Live preview and test console
This is the real form. Answer it to test the flow — nothing is sent or stored.
Page 1 of 2 — A typical day
This template runs as a straight sequence — no branching rules.
Works for you? Take Clara D.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Nutrition Intake Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in healthcare & clinical.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 19 questions across 2 screens.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 12 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It pins the request to a specific date.
- It allows multiple selections without free text.
- It captures a numeric value you can filter and sort on.
- Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
- Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Nutrition Intake Form lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 3 conditional rules ship with it.
- Features conditional validation: if “Has your weight changed in the last six months?” is Yes, “How much, and was it intended?” becomes mandatory before the form can be sent.
- Features conditional validation: if “Do you avoid any foods?” is Yes, “Which foods, and why?” becomes mandatory before the form can be sent.
- Features conditional validation: if “Do you cook for yourself?” is No, “Who prepares your food?” becomes mandatory before the form can be sent.
- All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Page 1 — A typical day
- Full namerequired
- Date of birthrequired
- A typical breakfastrequired
- A typical lunchrequired
- A typical evening mealrequired
- Snacks and drinks through the dayrequired
- Meals eaten out or delivered in a weekrequired
- Do you cook for yourself?required
- Who prepares your food?
Page 2 — Health and goals
- Relevant diagnoses
- Current medication and supplements
- Any of these symptoms?required
- Has your weight changed in the last six months?required
- How much, and was it intended?
- Do you avoid any foods?required
- Which foods, and why?
- Diagnosed allergy or intolerance
- What would you like to work on?required
- What have you already tried?
Conditional logic in this build
- When “Has your weight changed in the last six months?” is Yes, require “How much, and was it intended?”.
- When “Do you avoid any foods?” is Yes, require “Which foods, and why?”.
- When “Do you cook for yourself?” is No, require “Who prepares your food?”.
Questions about this shared form
Should we ask for a food diary as well?
Ask for one after the first appointment, when the patient knows why it helps. Requiring it before you have met tends to produce either nothing or a tidied-up version.
Is this suitable for paediatric dietetics?
Partly. A parent can complete it, but growth, feeding history and school meals need their own questions, so start from the Pediatric Intake Form and add these.
Does the form give any dietary advice?
No. It gathers what the patient reports and wants to work on; every recommendation comes from the dietitian in the consultation.
How do we use it at review?
Send the same form again and compare the typical-day answers. Change in the patient's own description is the outcome measure most patients recognise.
Is the Nutrition Intake Form template free to use?
Yes. You can preview and test Nutrition Intake Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Nutrition Intake Form template ask for?
It asks 19 questions across 2 pages, 12 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Nutrition Intake Form form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare & clinical form work?
3 conditional rules ship with the template: Features conditional validation: if “Has your weight changed in the last six months?” is Yes, “How much, and was it intended?” becomes mandatory before the form can be sent. Features conditional validation: if “Do you avoid any foods?” is Yes, “Which foods, and why?” becomes mandatory before the form can be sent. Features conditional validation: if “Do you cook for yourself?” is No, “Who prepares your food?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.
Where do responses to the Nutrition Intake Form form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Nutrition Intake Form form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
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