Get Client Assessment Questionnaire - Niu

The Client Assessment Questionnaire - Niu is designed to help gather essential information about your nutritional needs and health history. Completing this questionnaire online ensures a smooth process for you and the counseling team.

Follow the steps to complete your Client Assessment Questionnaire online.

1. Click the ‘Get Form’ button to access the questionnaire and open it in the online form editor.
2. Begin by filling out the demographic information section. Enter your name, date, address, cell and other phone numbers, email address, sex, best contact time, age, height, and weight.
3. In the section regarding weight changes, describe any fluctuations you have experienced in the past five years.
4. For your current physical activity level, select one option (Low, Moderate, High) and describe your typical physical activity, including both work-related activities and formal exercise.
5. In the health history section, indicate if you have any blood relatives with conditions such as cancer, diabetes, heart disease, high cholesterol, high blood pressure, osteoporosis, or thyroid disorders.
6. List any food allergies or intolerances you currently have.
7. Provide information about any prescribed medications you are taking, along with any over-the-counter, herbal, or vitamin/mineral supplements you consume.
8. In the diet history section, explain if you follow any special dietary plan and specify if you have previously followed a weight loss diet.
9. Indicate any foods that you do not consume and mention any changes you wish to make regarding your eating habits.
10. Select topics you hope to discuss in your one-on-one session, such as weight management, healthy food preparation, or meal planning.
11. Once all fields are completed, review your responses to ensure accuracy. You may then save your changes, download, print, or share the completed form as needed.

Complete your Client Assessment Questionnaire online to start your journey towards better nutrition.