undefined
HomeAll templatespatient consent formsnutrition consent form

Nutrition consent form

This is a nutrition consent form that can be used by nutrition clients. It includes information about nutrition counseling.

Time to complete

2 minutes

Eligibility

The consent form must be filled out by the parent/guardian of a child who wishes to enroll in the Nutrition program. If the child is 18 years or older, he/she must be the one to fill the form.

undefined

Questions for Nutrition consent form

1.

How do you prefer to receive information about nutrition? (i.e. pamphlets, online, etc.)

The answer should be a text input.
2.

What are your preferred methods of communication? (i.e. phone, email, text)

The answer should be a text input.
3.

How often would you like to receive updates on your progress?

The answer should be a single choice:
  1. Not often
  2. Often
  3. Very often
4.

What is your current nutritional knowledge?

The answer should be a single choice:
  1. No knowledge
  2. Reasonable knowledge
  3. Good knowledge
5.

What are your current eating habits?

The answer should be a text input.
6.

What are your current physical activity levels?

The answer should be a single choice:
  1. No physical activity
  2. Reasonable physical activity
  3. Good physical activity
7.

What are your current weight and height?

The answer should be a text input.
8.

What are your current health goals?

The answer should be a text input.
9.

What are your current medical conditions?

The answer should be a text input.
10.

Are you pregnant or breastfeeding?

The answer should be a single choice:
  1. Yes
  2. No
11.

Do you have any food allergies or sensitivities?

The answer should be a single choice:
  1. Yes
  2. No
12.

Do you have any religious or cultural dietary restrictions?

The answer should be a single choice:
  1. Yes
  2. No
13.

Do you have any other concerns or questions?

The answer should be a single choice:
  1. Yes
  2. No
14.

Do you give your consent to sign up for this nutrition program?

The answer should be a single choice:
  1. Yes
  2. No

Similar Ideas

  • Patient nutrition consent form
  • Nutrition education consent form
  • Nutrition research consent form
  • Parental consent form for nutrition education
  • Nutrition program consent form

Here are some FAQs and additional information
on Nutrition consent form

What is a nutrition consent form?

A nutrition consent form is a document that gives permission for a person to receive nutrition education or counseling from a registered dietitian or nutritionist.

Why is a nutrition consent form necessary?

A nutrition consent form is necessary in order to ensure that the person receiving nutrition education or counseling is aware of the potential risks and benefits associated with the service. It also helps to protect the dietitian or nutritionist from liability in the event that something goes wrong.

What information is typically included in a nutrition consent form?

A nutrition consent form typically includes information about the risks and benefits of the nutrition education or counseling service, as well as the dietitian or nutritionist's qualifications. It may also include a statement of consent from the person receiving the service.

Want to use this template?

Loved by people at home
and at work

undefined
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
undefined
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Nutrition consent form

1000+ Templates, 50+ Categories

Explore more
undefined
Nutrition consent form
This is a nutrition consent form that can be used by nutrition clients. It includes information about nutrition counseling.
undefined
Eyelash Extension Consent Form
An Eyelash Extension Consent Form is used to document a client’s agreement to having eyelash extensions applied. This form should be completed prior to the service in order to protect both the client and the technician.
undefined
Implant Removal Consent Form
The implant removal consent form is a document that is used by medical professionals to obtain consent from a patient for the removal of an implant. The form will typically include information about the risks and benefits of the procedure, as well as the potential complications that may occur. It is important that the patient understands all of the information on the form before signing it.
undefined
Tracheostomy Consent Form
The Tracheostomy Consent Form is a legal document that protects the medical practitioner from any legal liability in case the patient suffers any complications during or after the surgical procedure. The form also requires the patient’s signature, which gives the doctor the permission to carry out the tracheostomy.
undefined
Cataract Surgery Consent Form
Cataract surgery consent form is a document which is used by the patients who are willing to get their cataract surgery done by a certain surgeon. This form contains all the necessary information about the surgery and the patient’s consent for it. It is very important for the patient to read and understand all the information given in this form before signing it.
undefined
Psychology Consent Form
A psychology consent form is a form that is used by psychologists to obtain consent from their patients before conducting psychological research on them. This form typically contains information about the research project, the risks and benefits of participating in the research, and the patient's rights.
undefined
Ventilator Consent Form
A ventilator consent form is used when an individual is being placed on a ventilator for medical reasons. The form documents the individual's consent to the use of the ventilator and the individual's understanding of the risks and benefits associated with the use of the ventilator.
undefined
Therapy Consent Form
The Therapy Consent Form is a document that is used by a therapist to obtain consent from a patient for treatment. The form usually includes all relevant information about the treatment, including the risks and benefits. It should also explain the patient's rights and responsibilities.
undefined
Hair transplant consent form
The Hair transplant consent form is a form that is used by patients who are undergoing hair transplant surgery. This form is used to document the patient's consent to the procedure and to the use of their donor hair. The form also includes information about the risks and benefits of the procedure, as well as the patient's rights and responsibilities.
undefined
Sterilization Consent Form
A sterilization consent form is an important legal document that must be completed and signed by a patient who is about to undergo a surgical procedure to have their reproductive organs removed. The form outlines the risks, benefits, and alternatives to the procedure and must be signed by the patient in order to give their informed consent.
undefined
Amputation Consent Form
The Amputation Consent Form is a document that is used to give informed consent for an amputation procedure. The form will typically list the risks and benefits of the procedure, as well as the potential complications. It is important to read and understand the form before signing it.
undefined
Implant Consent Form
The Implant Consent Form is a document that is used when someone is considering having an implant procedure done. This form will help to ensure that the patient is fully informed about the risks and benefits associated with the procedure. It is important to read and understand this form completely before signing it.
undefined
Dental Treatment Consent form
Dental treatment consent form is a type of form which is used by the dental clinics to know the consent of the patients regarding the dental treatment. This form is very important for the dental clinics as it helps them to know whether the patient has agreed for the treatment or not. This form also includes the details of the treatment which will be given to the patient.
undefined
Blood Transfusion Consent Form
Blood transfusion consent form is used by patients who need to receive blood transfusions. This form gives the patient's permission for the doctors to transfuse blood into their body. The form also includes information about the risks and benefits of transfusions, as well as the patient's rights.
undefined
Medical Consent Form
A medical consent form is a document that is used to give another person permission to provide medical treatment to you or your minor child. This form is also sometimes referred to as a medical release form or a healthcare authorization form.

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE