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Nutrition evaluation form

The nutrition evaluation form is used to assess the nutritional status of an individual. These forms help to identify individuals who are at risk for malnutrition or who may need nutritional intervention. Nutrition evaluation forms can be used to screen for malnutrition, assess the adequacy of nutrient intake, and monitor changes in nutritional status over time.

Time to complete

3 minutes

Eligibility

The nutrition evaluation form is available to all patients of the health centre.

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Questions for Nutrition evaluation form

1.

How many meals do you eat per day?

The answer should be a text input.
2.

What is your favourite food?

The answer should be a text input.
3.

What is your favourite beverage?

The answer should be a text input.
4.

What is your favourite snack?

The answer should be a text input.
5.

What is your favourite condiment?

The answer should be a text input.
6.

What is your favourite food group?

The answer should be a text input.
7.

What is your least favourite food group?

The answer should be a text input.
8.

What is your favourite type of food?

The answer should be a text input.
9.

What is your favourite food texture?

The answer should be a text input.
10.

What is your favourite food flavour?

The answer should be a text input.
11.

What is your favourite food smell?

The answer should be a text input.
12.

What is your favourite food colour?

The answer should be a text input.
13.

What is your favourite food combination?

The answer should be a text input.
14.

What is your favourite food to eat when you are hungry?

The answer should be a text input.
15.

What is your favourite food to eat when you are full?

The answer should be a text input.
16.

What is your favourite food to eat when you are bored?

The answer should be a text input.

Similar Ideas

  • Health assessment form
  • Nutrition assessment form
  • Dietary assessment form
  • Nutritional assessment form
  • Nutrition screening form

Here are some FAQs and additional information
on Nutrition evaluation form

How often should I conduct a nutrition evaluation?

A nutrition evaluation should be conducted every three to six months, or as recommended by your healthcare provider.

What is the purpose of a nutrition evaluation?

The purpose of a nutrition evaluation is to assess one's current eating habits and nutritional status and to make recommendations to improve his/her diet and overall health.

What information will I need to provide during a nutrition evaluation?

During a nutrition evaluation, you will be usually asked to provide information about your medical history, eating habits, and lifestyle. You may also be asked to provide a list of the foods you eat on a regular basis, as well as any supplements you take.

What can one expect during a nutrition evaluation?

During a nutrition evaluation, a registered dietitian or nutritionist will assess one's current eating habits and nutritional status. They will then make recommendations to improve their diet and overall health.

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