Do you find yourself spending more time creating the perfect intake form than treating your nutrition clients?


If so, this is one of those forms that will save YOUR time.


The questions are perfect for you if you work with people who are looking to heal their relationship with food, continue recovering from eating disorders, or if you are an anti-diet dietitian!


I promise it’ll be worth it when you get your time back from getting the information that you need – because who doesn’t want to spend less TIME doing what they love???


With the Canva template, you can customize them with your colors and logo and then seamlessly integrate them onto your website or social media page in just minutes!


  • Canva Pro template – Customizable for your branding
  • Canva Pro template is editable if you need to make any changes to the information requested
  • 8-page intake form that looks modern and professional
  • Includes the following sections:
  • Personal information
  • Emergency contacts
  • Lifestyle information
  • Family history
  • Personal health history
  • Weight history/fluctuation history
  • Food and exercise behavior history
  • Hospitalization/surgery history
  • Medications
  • Supplements
  • Allergies
  • Diet
  • Diet recall

PLEASE NOTE: YOU WILL NEED A CANVA PRO SUBSCRIPTION FOR SOME OF THE PHOTOS AND FONTS (or you can just change them to your own fonts and photos)

INSTANT DOWNLOAD: Once you purchase this item, it will be available for instant download.

LICENSE: You may not share, sell, or distribute the file.

Copyright 2024 © Vickery Wellness, LLC and Declet Designs, LLC. Vickery Wellness, LLC and Declet Designs, LLC retains all rights to the design and file.

Because this is a digital file, no refunds will be made.

Declet Designs

Digital products for private practices

$12.99

What You'll Get:

1 Canva Template for the New Client Intake Form

  • 1 Files
  • Intake form template canva.pdf
    261.2 kB
  • 1 pages (~109 words)