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Diet Plan Feedback Form Template

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Client Details

Diet Information

Physiological Info

Lifestyle Habits

Medical History

The Diet Plan Feedback Form Template from WPForms is designed for nutritionists, dietitians, and health coaches who need a straightforward method for gathering feedback on the dietary plans they provide clients.

How Does the Diet Plan Feedback Form Template Work?

To effectively utilize this form, you only need the WPForms Basic License, which supports various advanced fields for comprehensive data gathering. Here’s a brief description of the fields included in the template:

  • Client Details:
    • Name: Collects the client’s full name for personalization of the feedback.
    • Gender: Analyze feedback based on different nutritional needs based on gender.
    • Date of Birth: Important for understanding age-specific dietary feedback.
    • Email Address: Used to send further communication or diet-related updates.
  • Feedback on Diet:
    • Current Diet Pattern: Gathers client’s views on their current dietary habits.
    • Meal Frequency: Seek feedback on the recommended meal frequency.
    • Dietary Restrictions: Checks if nutritional restrictions are adequately accommodated.
    • Food Preferences: Assesses whether the diet aligns with the client’s preferred foods.
    • Favorite Foods: Queries if favorite foods were considerately included in the diet plan.
    • Least Favorite Foods: Ensures the plan avoids foods the client dislikes, enhancing satisfaction.
  • Physiological Information:
    • Weight Goals: Evaluates if the diet plan is effectively supporting the client’s goals.
    • Current Weight: Measures progress towards or maintenance of desired weight.
    • Height: Used to discuss body mass index changes or concerns.
    • Exercise Routine: Reviews how the diet complements the client’s physical activity.
  • Lifestyle and Medical History:
    • Smoking Habits: How smoking may have influenced the diet’s effectiveness.
    • Alcohol Consumption: Considers the impact of alcohol on achieving dietary goals.
    • Drug Addiction: Addresses any dietary adjustments needed due to drug use.
    • Fluid Intake: Feedback on hydration recommendations and their adequacy.
    • Current Health Conditions: Monitors if the diet better manages health conditions.
    • Allergies: Ensures that dietary plans did not trigger any allergic reactions.
    • Medications Being Taken: Discusses any food and medication interactions.
    • Previous Surgeries: Considers past surgeries that might affect dietary requirements.

Sign up with WPForms today to access the Diet Plan Feedback Form Template. This template is excellent for professionals who want to refine their dietary recommendations based on client feedback.