Get Northwestern Memorial Physicians Group Nutrition Therapy Introductory Questionnaire

The Northwestern Memorial Physicians Group Nutrition Therapy Introductory Questionnaire is a crucial document that helps tailor nutrition therapy to meet individual needs. This guide provides a clear, step-by-step approach to completing the questionnaire online, ensuring that your information is conveyed accurately and efficiently.

Follow the steps to complete your questionnaire effectively.

1. Press the ‘Get Form’ button to access the questionnaire and open it in your online editor.
2. Begin by entering the date in the designated field at the top of the form. This is important for record-keeping.
3. Complete the personal information section by filling in your name, the name of your primary or referring physician, and their contact details. This helps facilitate communication between healthcare providers.
4. Move to the marital status section and select the appropriate option that reflects your current status.
5. Indicate your employment status by selecting either ‘Employed’ with your occupation noted, or ‘Student’.
6. Describe the main reason for your visit in the text field provided. Be as specific as possible to aid your nutrition therapist.
7. List any questions or concerns you have that you wish to address during the visit in the designated space.
8. State your primary objective for the visit clearly in the respective section.
9. In the health history portion, detail any medical conditions, medications, and supplements you are currently taking.
10. If applicable, provide information regarding diabetes management, including any concerns, past education, and how it affects various aspects of your health.
11. Record tobacco use, alcohol consumption habits, drug use, and sleep patterns to give your health provider a complete view of your lifestyle.
12. Complete the weight history section with your current weight and height, as well as historical body weight if known.
13. Answer the nutrition-related questions focusing on allergies, intolerances, and any lifestyle diets that may influence your eating habits.
14. Describe your usual eating patterns and list any typical meals or snacks consumed throughout the day.
15. Indicate your participation in physical activity and any physical activities you wish to pursue.
16. If weight loss is not your main goal, skip the remaining questions; otherwise, answer the series of questions regarding your weight loss history and current challenges.
17. Review all your entries for accuracy. Once satisfied, you can proceed to save the changes made to the document.
18. Finally, download, print, or share the completed questionnaire as needed.

Start filling out the Northwestern Memorial Physicians Group Nutrition Therapy Introductory Questionnaire online today to take the first step in personalizing your nutrition therapy.