social-facebook facebook cloud lock google instagram twitter linkedin

Dietary Assessment Questionnaire Template

The diet assessment questionnaire can be used to study an individual’s eating habit and dietary plan. With this questionnaire, individuals can fill out their food preferences, allergies, habitual diet, dietary history, and so on. Get started with this questionnaire by either embedding it on your website or by using it as a standalone form.

Use this template Tips for using template
Form Categories



Dietary Assessment Questionnaire Template template

By Type

By Industry

Tips For Using the Dietary Assessment Questionnaire Template

Dietary assessments provide an in-depth understanding of patients' nutritional status and how it affects their health. They also help you make effective recommendations to improve the patient's diet. 

What Is the Objective of Dietary Assessment?

The goal of dietary assessment is to get accurate and trustworthy information about a person's dietary habits. You can use the information to assess a person's nutritional status, identify areas for diet improvement, develop individualized nutrition plans, and track the impact of nutrition interventions.

How Do I Create a Dietary Assessment Questionnaire Form?

Step 1- Go to the dietary assessment questionnaire form

Step 2- Edit the form fields to fit your assessment objectives

Step 3- Choose your preferred settings such as form privacy, submission notification, and others.

Step 4- Share your form with patients via email, social media, QR code, or embed on a webpage.

Step 5- Collect and analyze responses in real-time.

What Are the 3 Major Types of Dietary Assessment?

Self-reported dietary assessment: This assessment involves the participant's self-monitoring of their food intake. You can do this with a food diary, food frequency questionnaire, or 24-hour dietary recall.

Direct observation dietary assessment: This is when a trained professional watches a client or patient eats. It is typically done in the patient’s natural setting and sometimes in a clinic.

Biomarker-based dietary assessment: using blood, urine, or other bodily fluid to assess a person's dietary intake.

What Is Included in a Dietary Assessment?

Food intake: amount and types of foods and drinks the person eats and drinks.

Nutrient intake: amounts of various nutrients the person consumes.

Food-related behaviors: eating habits, such as how often the person eat out, snack, and exercise.

What 5 Assessments Must Be Included in a Nutritional Patient Assessment?

Dietary intake: The types of foods and beverages the patient eats, the amount, and the frequency.

Nutritional status: patient’s weight, height, body mass index (BMI), and blood levels of nutrients.

Food allergies and intolerances: This assessment should identify any food allergies or intolerances that the patient has.

Medications: patient’s past and present medications that could affect their nutritional status.

Social and economic factors: Social or economic problems that could hinder the patient's ability to eat a nutritious diet.

Need a more effective way to assess patient diet? Get started with the formplus dietary assessment questionnaire template.

You may also like:

[[ template['name'] || '' ]] template

[[ template['name'] ]]

[[ template['description'].substring(0, 100) ]]

Preview this template