Nutrition screening form 2026

1. Click ‘Get Form’ to open the nutrition screening form in the editor.
2. Begin by entering your personal information at the top, including your name, date of birth, and the date of completion.
3. Fill in the referring healthcare provider's details and provide a brief reason for your nutritional consult in the Medical/Social History section.
4. List any current diagnoses, medications, allergies, and medical conditions. This information is crucial for a comprehensive assessment.
5. Complete the height, weight, and age fields accurately. Include your usual body weight history for better context.
6. Indicate smoking status and alcohol use. If applicable, provide details about physical activity levels.
7. In the Diet History section, note any supplements you take and describe your eating patterns and environment.
8. Finally, complete the Diet Recall section by detailing your food group servings per day and week to give a clear picture of your dietary habits.

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