Intake Forms for Nutritionists and Dietitians: Diet History, Medical Conditions, and Treatment Goals

By Daniel Akselrod · July 2026

A new client sits down and says they want to “eat healthier.” That means nothing. It means everything. It could mean they just got an A1c result of 8.2 and their endocrinologist told them to see a dietitian or start metformin. It could mean they’re a competitive CrossFit athlete trying to cut weight for a meet without losing strength. It could mean they have a history of anorexia and “eating healthier” is a euphemism for restriction patterns that need clinical oversight, not a meal plan.

You will not know which of those clients you are sitting across from unless your nutrition and dietetics intake form asks the right questions before the consultation starts. Nutrition counseling is inherently medical for a large portion of clients, and even for the wellness-oriented segment, dietary recommendations without a full history are guessing. Here is what your intake form needs to capture.

Dietary history: what they eat now and what they’ve tried

Before you can recommend changes, you need a baseline. Your intake should build a picture of the client’s current eating patterns and their history of dietary interventions:

• Typical daily eating pattern — number of meals and snacks per day, approximate meal times, whether they skip meals regularly, whether they eat breakfast. This is not about getting a perfect 24-hour recall (that comes in session). It is about identifying structural patterns — the person who eats nothing until 2 p.m. and then grazes until midnight has a completely different intervention point than the person eating three structured meals that are nutritionally imbalanced.
• Previous diets or programs — keto, Whole30, Weight Watchers, paleo, vegan, intermittent fasting, medically prescribed diets. What did they try? How long did they sustain it? What happened when they stopped? This history tells you which approaches they’ve already failed on (and will resist repeating) and which ones may have worked but weren’t sustainable.
• Cooking frequency and skill level — a meal plan full of from-scratch recipes is useless for someone who microwaves every meal. Conversely, a client who cooks daily and enjoys it is going to be insulted by a plan built around protein shakes and frozen entrees. Match the plan to the person.
• Eating out frequency — how often they eat at restaurants, order delivery, or eat at a workplace cafeteria. For clients who eat out ten or more meals per week, the intervention isn’t about teaching them to cook — it’s about teaching them to navigate menus.
• Alcohol and caffeine intake — both affect hydration, sleep, caloric balance, and interaction with medical conditions. A client drinking 600 calories of craft beer per week has found their surplus without you looking at their food log.

Food allergies, intolerances, and restrictions

This section is non-negotiable and must be thorough. A missed allergy isn’t just a bad recommendation — it’s a medical event waiting to happen.

• True allergies — IgE-mediated reactions to tree nuts, peanuts, shellfish, fish, milk, eggs, wheat, soy, sesame (added to the top-nine allergen list in 2023). Severity matters: a client with mild oral allergy syndrome to raw apples is a different situation than a client who carries an EpiPen for peanut anaphylaxis.
• Intolerances and sensitivities — lactose intolerance, fructose malabsorption, histamine intolerance, sulfite sensitivity. These don’t cause anaphylaxis but they determine which foods cause GI distress, headaches, or skin reactions.
• Celiac disease vs. gluten sensitivity — a diagnosed celiac patient requires strict gluten avoidance with cross-contamination awareness. A client who feels “better off gluten” without a diagnosis may benefit from a structured elimination protocol rather than permanent avoidance.
• Religious, ethical, and cultural restrictions — halal, kosher, vegetarian, vegan, pescatarian, Hindu dietary laws, Jain dietary restrictions, fasting practices (Ramadan, Lent, intermittent religious fasts). These are non-negotiable for the client and your plan must respect them without treating them as obstacles.

Medical nutrition therapy conditions

This is where the line between wellness coaching and clinical practice gets drawn. A registered dietitian providing medical nutrition therapy (MNT) needs a comprehensive medical history because the diet recommendations are part of the treatment plan, not a lifestyle upgrade.

• Diabetes (Type 1, Type 2, gestational, prediabetes) — current medications (insulin type and dosing schedule, metformin, GLP-1 agonists), most recent A1c, blood glucose monitoring frequency, history of hypoglycemic episodes. Carb counting proficiency matters — a newly diagnosed Type 2 patient needs a completely different educational approach than a Type 1 patient who has been carb counting for fifteen years.
• Chronic kidney disease — current stage, GFR, whether they are on dialysis, potassium and phosphorus restrictions, protein requirements (which change dramatically between pre-dialysis CKD and dialysis patients). A renal diet is one of the most restrictive and counterintuitive diets in clinical practice.
• Cardiovascular disease — current lipid panel (LDL, HDL, triglycerides), blood pressure, statin use, history of cardiac events. The dietary intervention for high triglycerides (reduce refined carbs and alcohol) is different from the intervention for high LDL (reduce saturated fat, increase soluble fiber).
• Eating disorders — history of anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, orthorexia. This is the most important screening question on the form because it fundamentally changes the approach. A client with active or recovering disordered eating should not receive calorie targets, restrictive meal plans, or weight-focused goals. If your intake identifies a potential eating disorder, the appropriate response may be referral to a therapist who specializes in EDs before starting nutrition work.
• GI conditions — IBS, IBD (Crohn’s, ulcerative colitis), GERD, gastroparesis, SIBO, diverticular disease. Each has specific dietary protocols (low-FODMAP for IBS, texture-modified diets for gastroparesis, trigger avoidance for GERD).

Supplement and medication review

Clients often take supplements without mentioning them because they don’t think of them as relevant to nutrition counseling. They are. Your intake needs a dedicated section:

• Current supplements — multivitamins, vitamin D, omega-3s, probiotics, protein powders, creatine, iron, calcium, B12, herbal supplements (turmeric, ashwagandha, elderberry). Include dose, frequency, and brand if possible. Many clients are taking redundant supplements or doses that are too low to be therapeutic.
• Prescription medications that interact with diet — warfarin (requires consistent vitamin K intake), metformin (B12 depletion risk), lithium (sodium and fluid balance critical), MAOIs (tyramine restriction), thyroid medication (calcium and iron timing). Your recommendations cannot contradict a physician’s pharmaceutical management.
• Over-the-counter medications — antacids (calcium and magnesium effects), laxatives (electrolyte balance), NSAIDs (GI impact). Chronic OTC use often indicates an underlying issue that nutrition counseling can address.

Lab work interpretation

If your client is coming from a physician referral, they may arrive with lab work. Your intake should ask them to bring or upload their most recent results. The labs that inform nutrition planning include:

• A1c and fasting glucose — diabetes management baseline
• Lipid panel — total cholesterol, LDL, HDL, triglycerides
• Comprehensive metabolic panel — kidney function (BUN, creatinine, GFR), liver function (ALT, AST), electrolytes (sodium, potassium), blood glucose
• CBC — hemoglobin and hematocrit (anemia screening), MCV (B12/folate deficiency)
• Iron studies — ferritin, serum iron, TIBC (iron deficiency is one of the most common nutritional deficiencies worldwide)
• Vitamin D (25-hydroxy) — deficiency is widespread and affects bone health, immune function, and mood
• Thyroid panel — TSH, free T4 (hypothyroidism significantly affects weight and metabolism)

Not every client will have labs. But asking for them at intake signals clinical competence and separates your practice from wellness influencers making diet recommendations without any clinical context.

Weight history vs. body composition goals

Weight is a loaded topic. Your intake form needs to handle it carefully while still collecting the clinical data you need.

Ask for current weight and height (needed for BMI calculation, caloric needs, and protein targets). Ask about weight history — highest adult weight, lowest adult weight, weight five years ago, weight one year ago. This trend line tells you more than today’s number. A client who has gradually gained 40 pounds over ten years has a very different metabolic profile than a client who gained 40 pounds in six months after starting a new medication.

Separate weight goals from body composition goals. Many clients say they want to “lose weight” when what they actually want is to look and feel different — which may involve gaining muscle while losing fat, a process where the scale might not move at all. Your intake should ask what specific outcomes they are looking for, whether they have experience with body composition measurement (DEXA, InBody, calipers), and whether they are working with a personal trainer simultaneously.

Meal prep capacity and food access

The best meal plan in the world fails if the client can’t execute it. Your intake should assess practical barriers:

• Kitchen access — do they have a full kitchen, a kitchenette, a dorm microwave, or a break room fridge at work? Meal planning for a college student with a mini-fridge is a different exercise than meal planning for someone with a full kitchen and a Costco membership.
• Grocery access — proximity to grocery stores, access to transportation, food budget, whether they live in a food desert. Recommending wild-caught salmon three times a week to a client whose nearest grocery store is a Dollar General is not a plan — it’s a fantasy.
• Time available for food prep — do they batch cook on weekends, cook nightly, or need grab-and-go options? Realistic time assessment prevents plan abandonment.
• Household dynamics — are they cooking for one or for a family? A parent cooking for picky children has different constraints than a single adult. Does anyone else in the household have dietary needs that affect shared meals?

RD vs. nutritionist: scope matters at intake

The intake form itself should reflect your scope of practice. A registered dietitian (RD or RDN) can provide medical nutrition therapy, interpret lab work, and treat diagnosed conditions. A nutritionist (in most states) operates in the wellness space — general nutrition education, meal planning, supplement guidance — but cannot diagnose or treat medical conditions. Your intake form should capture the data appropriate to your credential level. If your intake reveals a medical condition that falls outside your scope, the form itself should prompt referral rather than treatment.

A thorough nutrition and dietetics intake form gives you the clinical and practical context to write plans that work for real people with real constraints — not generic macro splits pulled from a textbook.

For related reading on health practitioner intake, see our guide to intake forms for acupuncturists.