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Nutrition Intake Form Template
I need a Nutrition Intake Form Template for my private nutrition practice in Cardiff that includes comprehensive sections for food allergies and intolerances, as I specialize in working with clients who have multiple dietary restrictions and autoimmune conditions.
1. Personal Information: Basic client details including name, contact information, age, gender
2. Medical History: Current health conditions, medications, allergies
3. Dietary Information: Current eating habits, food preferences, restrictions
4. Lifestyle Information: Exercise habits, occupation, stress levels, sleep patterns
5. Privacy Notice: GDPR-compliant information about data handling
6. Consent Declaration: Client's agreement to data processing and nutritional advice
1. Family Medical History: Optional section for recording relevant genetic factors and family health history when comprehensive health assessment is needed
2. Supplement Usage: Optional section for recording current supplementation details when client uses or needs supplements
3. Weight History: Optional section for documenting past weight changes and goals, particularly relevant for weight management clients
4. Food Diary: Optional section for detailed food intake recording when detailed dietary analysis is required
1. Food Diary Template: Standard format for recording daily food intake
2. Privacy Policy: Detailed data protection and privacy information
3. Terms and Conditions: Service terms and liability limitations
4. Measurement Recording Sheet: Template for tracking anthropometric measurements
Authors
Client
Personal Data
Sensitive Personal Data
Medical History
Dietary Requirements
Food Allergies
Food Intolerances
Nutritional Assessment
Consultation
Treatment Plan
Dietary Goals
Health Information
Lifestyle Information
Consent
Privacy Notice
Data Protection Legislation
Services
Professional Body
Medical Professional
Supplements
Dietary Restrictions
Medical Conditions
Medications
Treatment Records
Confidential Information
Practice
Healthcare Provider
Emergency Contact
Assessment Period
Medical History
Dietary Assessment
Lifestyle Assessment
Data Protection
Confidentiality
Consent
Privacy Notice
Information Sharing
Record Keeping
Emergency Contacts
Health and Safety
Disclaimers
Medical Disclosure
Allergies and Intolerances
Medication Declaration
Professional Boundaries
Service Limitations
Information Updates
Communication Preferences
Medical Release
Liability
Documentation Requirements
Reporting Obligations
Data Storage
Information Access Rights
Withdrawal of Consent
Professional Standards
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