Get Nutritional Assessment

Completing the Nutritional Assessment is an important step towards receiving a personalized wellness plan. This guide will assist you in filling out the form online, ensuring that all information is provided accurately and comprehensively.

Follow the steps to complete your Nutritional Assessment with ease.

1. Click ‘Get Form’ button to access the Nutritional Assessment form and open it in your preferred online editor.
2. Begin by entering your personal information. Fill in your name and date of birth in the designated fields. Remember to provide accurate information for your records.
3. Select your gender by circling either 'Male' or 'Female'. Next, indicate your age in the appropriate field.
4. Enter your address, email address, and phone numbers. Make sure to specify which phone number is best for contact and during what times.
5. Provide information about your availability for meetings and your occupation, including work hours and the number of hours worked per week.
6. Describe your relationship status and provide information about your children, including their ages and whether they live with you.
7. In the Present/Past Medical Conditions section, input your height and current weight. Provide historical weight if available and indicate if you wish to change your weight.
8. Check any current or past medical conditions that apply to you from the list provided, including heart disease, diabetes, and food allergies.
9. List your main health concerns and what you hope to achieve through nutritional counseling in the designated area.
10. Indicate if you follow a special diet and list any medications, vitamins, minerals, or herbal supplements you are currently taking.
11. Reflect on any diets or weight-loss plans you have previously followed and note which were most effective, as well as barriers you faced in achieving wellness goals.
12. Identify who is responsible for meal planning, preparation, and grocery shopping, as well as the frequency of dining out and typical restaurant choices.
13. Convey how many meals you eat daily, your eating pace, and where you typically consume meals and snacks.
14. List any problem foods you tend to overindulge in, your favorite foods, and those you dislike.
15. Detail your beverage intake and describe a typical day's meals, including meal times and specific food items consumed.
16. Once you have filled out all sections, review your responses for accuracy. Save your changes, download the completed form, and print or share it as needed.

Start completing your NUTRITIONAL ASSESSMENT online today for a tailored wellness plan.