Know which nutrition evaluation leads are worth appointment time
This intake asks about the patient's evaluation goal, prior nutrition history, and any medically prescribed diet, then collects meal notes and allergy details so your team knows what to review before confirming an appointment.
The exact intake your nutrition evaluation leads complete
This is the real 6-question guided intake for Nutrition Evaluation — the same flow your customers finish before you ever pick up the phone.
What a qualified nutrition evaluation lead should tell you
A structured intake that captures a patient's diet history, current goal, any medically prescribed restrictions, and allergy information so the provider can assess nutritional status and plan the right first appointment.
- This Nutrition Evaluation
- Main Goal This Evaluation
- This Person Had Nutrition
- This Person Follow Any
- Soon Schedule This Evaluation
- There Any Food Allergies
The questions your team needs answered
Every nutrition evaluation intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Who is this nutrition evaluation for? | Distinguishes a self-referral from a pediatric or caregiver-booked visit, which changes the consent and documentation staff need to prepare. |
| What is the main goal for this evaluation? | Weight-loss and medical-condition-support goals carry the highest scoring weight, helping staff prioritize which enquiries need clinical review first. |
| Has this person had a nutrition evaluation before? | Shows whether records need to be pulled from a previous evaluation or whether this is genuinely a first-time patient. |
| Does this person currently follow any medically prescribed diet or restriction? | Surfaces patients already under an active medically prescribed diet so they aren't booked into a slot that doesn't fit their existing plan. |
| How soon are you hoping to schedule this evaluation? | An 'as soon as possible' answer scores higher than 'flexible', helping staff spot patients ready to book now versus those still exploring. |
| Are there any food allergies or intolerances the provider should know about? | The open-text allergy answer gives the provider specific details to review before the appointment instead of collecting them again in person. |
How Cliont scores nutrition evaluation leads
Every answer is weighted automatically — no manual review required.
Value signals
- Weight loss support
- Healthy weight gain
- General diet improvement
- Support for a medical condition
- As soon as possible
- Within a month
Disqualifiers
- Not sure yet
See the lead your team receives
Nutrition Evaluation Lead
From first click to qualified lead
Follow patients and caregivers through one smooth, guided flow.
They land & meet you
Your video greeting plays instantly — a real face instead of a blank form.
They explain the visit
Smart questions adapt to their visit and capture the full scope.
They share details
Symptoms, history, and documents come attached before the visit.
You get a ready lead
Scored and qualified — waiting for you to win it.
Built for nutrition evaluation workflows
| Cliont capability | Nutrition Evaluation application |
|---|---|
| Conditional routing | Answers to who the evaluation is for (self, child, or another adult) route to different downstream notes so staff know whether parental consent or caregiver context is needed. |
| Weighted lead scoring | Goal answers are scored individually, so a medical-condition or weight-loss goal ranks above a general diet improvement or 'not sure yet' response without staff reviewing every submission by hand. |
| Structured yes/no flags | The medically prescribed diet question creates a clear flag in the CRM record so the evaluator can pull existing orders before confirming the appointment slot. |
| Free-text capture | Open-ended allergy and intolerance answers are stored verbatim on the lead record instead of being forced into a checkbox list that might miss what the patient actually reports. |
Common nutrition evaluation lead scenarios
Self-referral wanting fast scheduling
An adult selects weight loss support as the goal and wants to be seen as soon as possible, which scores high on both the goal and timing questions and should surface at the top of the queue.
Parent booking for a child
The 'who is this for' answer shows a parent submitting on behalf of a child with a healthy weight gain goal, which changes what the front desk needs to prepare before the visit.
Patient already on a medical diet
The patient answers yes to already following a medically prescribed diet or restriction, flagging that the evaluator should review existing dietary orders before the appointment rather than starting from scratch.
Exploratory enquiry, no timeline pressure
The patient selects 'Not sure yet' for the goal and 'Flexible, just exploring options' for timing, indicating a lead that's still deciding rather than ready to book.
Returning patient after a year away
The intake shows a prior evaluation more than a year ago combined with a general diet improvement goal, useful for distinguishing re-engagement visits from new-patient intakes.
Connect Cliont to your workflow
Send leads
HubSpot, HighLevel, Salesforce, JobNimbus
Book visits
Google Calendar, Outlook Calendar, Calendly
Notify your team
Email, SMS, Slack
Automate follow-up
Zapier, Webhooks, API
Simple, transparent pricing
Choose the plan that works for your business.
Professional
Unlimited intake forms and leads for your growing business.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Advanced analytics dashboard
Pay Per Lead
Only pay when you receive a qualified lead.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Charged only for submitted leads
More weight management intake templates
Nutrition Evaluation lead-intake FAQs
How does the intake handle evaluations booked by a parent or caregiver instead of the patient?
The first question asks who the evaluation is for, so answers submitted on behalf of a child or another adult are labeled clearly before they reach your CRM, letting front desk staff prepare the right consent and documentation.
Does the form catch patients who are already on a medically prescribed diet?
Yes. A dedicated yes/no question flags any existing prescribed diet or restriction so the provider can review it ahead of the appointment instead of discovering it during the visit.
How are different evaluation goals scored?
Weight loss support, healthy weight gain, and support for a medical condition carry the highest scoring weight, while a general goal or 'not sure yet' scores lower, helping staff triage which enquiries need clinical attention first.
What happens to the free-text allergy answer?
The allergy and intolerance question is open text, and the response is carried through to the CRM record so the provider has it on hand before the appointment rather than collecting it again in the room.
Can the intake tell new patients apart from returning ones?
Yes, the prior evaluation question captures whether this is a first evaluation, one within the past year, or one from over a year ago, which helps staff decide whether to request prior records.
How is this different from the Medical Weight Management or Metabolic Health Evaluation intake?
This intake focuses on diet, goals, and food-related restrictions rather than medication history or metabolic testing, so it's built for practices screening for a nutrition-focused first visit rather than a medical weight management or metabolic workup.
Turn nutrition evaluation visitors into qualified patients
Give every nutrition evaluation visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book front-desk time.