Clinically speaking, have you ever returned to your desk after a patient assessment and realized a few vital questions were left unasked? Thinking to yourself, how did I forget those, but it has happened to me especially during those crazy busy days. Before you know it, you’re back visiting the same patient asking those few “forgotten” questions. Let’s rid those unanswered questions!

Eliminate unasked questions which result in a re-visit, adding more time to your day. This form is designed to gather all client information in one visit.

With this clinical nutrition assessment form, you will be able to:

  • Formulate an educational outline prior to entering the room.
  • Gather needed information during the first visit.
  • Eliminate double visits & save time to chart thoroughly during days of increased patient loads.
  • Achieve higher quality of patient care by gathering the essential data needed to formulate a nutritional intervention.
  • Cover the nutrition care process thoroughly.

Both paper & computer versions available. Suitable for the clinical & acute care setting.

With your purchase you will get not 1, but 2 versions of this assessment form.

Key Features: Hard Copy

  • Printer friendly in a PDF format
  • Works well in clinical and acute care settings
  • Ques questions to ask during interview
  • Added space to jot notes
  • Non-branded

Key Features: Electronic Version

  • Exclusively compatible with Microsoft Word
  • Calculations included to lessen time of looking up information
  • Flexibility to add more space or rearrange to your liking

***Requirements: need Microsoft Word skills as the electronic version is exclusive to Microsoft Word and requires Microsoft Word to open the electronic version form.


Average rating: 2.00 out of 5 stars
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  • Out of date....

    I was disappointed in some of the outdated info on the form…like protein needs being based on albumin levels which is no longer a standard of practice. It makes me leery about purchasing other products on this website because I’m afraid other items are out of date too.

    • Hi there!
      I’ve recently updated my forms on the website. This form is currently used by myself and other RD’s at the hospital I am employed at. Rest assured the information is correct and up to date. The protein needs relating to albumin levels was a point of reference.
      The great thing about these forms is that they come in a pdf and electronic version so that customers can easily rearrange, add and/or remove items to their likely.
      Thank you! 🙂

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