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Prenatal Nutrition Intake Form

Run a gentle, thorough intake for supporting nutrition through pregnancy, capturing stage, symptoms, and preferences in one form.

Description

The Prenatal Nutrition Intake Form gives practitioners a gentle, thorough way to support clients through pregnancy. It captures which stage they are at, how many weeks pregnant if known, and how they have been feeling, so you understand each client’s experience with care and sensitivity.

Fields for any symptoms, prenatal supplements, pregnancy-related conditions, dietary preferences, and foods they are avoiding complete the picture, while a consent step covers the sensitive information involved. Capturing all this thoughtfully means your support is safe, personal, and reassuring.

Gentle, informed support means a lot in pregnancy. Sign up for a free Fun Forms account to customize the fields and embed this intake form on your website.

Form fields

Everything the Prenatal Nutrition Intake Form above collects — 11 fields across 2 pages, so you can see exactly what it captures before you make it your own.

Nourishing You & Baby

  • Which stage are you at?

    Dropdown Icon
    Dropdown

  • How many weeks pregnant are you (if known)?

    Number Icon
    Number

  • How have you been feeling — energy, appetite, any symptoms?

    Long Answer Icon
    Long Answer

  • Are you experiencing any of these?

    Multi-Select Icon
    Multi-Select

  • Are you taking a prenatal supplement?

    Yes/No Icon
    Yes/No

  • Any pregnancy-related conditions we should know about?

    Long Answer Icon
    Long Answer

  • Any dietary preferences?

    Multi-Select Icon
    Multi-Select

  • Foods you're avoiding or worried about?

    Long Answer Icon
    Long Answer

Your Details

  • Your name

    Name Icon
    Name

  • Email address

    Email Icon
    Email

  • Consent

    Consent Icon
    Consent
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Template FAQs

Common questions about the Prenatal Nutrition Intake Form — what it captures, when to use it, and how to make it your own.

What is a prenatal nutrition intake form?

A prenatal nutrition intake form is an online form clients use to share information for nutrition support during pregnancy. It captures their stage, symptoms, supplements, and preferences, so a practitioner can support them safely, gently, and personally through this important time.

Why ask which stage of pregnancy a client is at?

Nutritional needs and common symptoms change across pregnancy, so knowing the stage helps you support the client appropriately. It lets you tailor guidance to what matters at their point in pregnancy and respond sensitively to how they are likely to be feeling.

Why ask about prenatal supplements?

Knowing whether a client takes a prenatal supplement is important context for their overall nutrition during pregnancy. It helps you understand what they are already doing and support them appropriately, while working alongside their maternity care team rather than giving medical advice.

Why ask about foods a client is avoiding?

Pregnancy comes with foods to avoid and often personal worries or aversions. Capturing what a client is avoiding or concerned about lets you offer reassurance and practical alternatives, so they can eat well and confidently without anxiety during their pregnancy.

Why include a consent step?

Pregnancy and health information is highly sensitive, so a consent step ensures the client agrees to how it will be used. It supports responsible, caring handling of their information and gives you a clear, recorded acknowledgment as you begin supporting them.

Is the prenatal nutrition intake form free?

Yes, this prenatal nutrition intake form is completely free, and you can customize the fields to fit your practice, embed it on your website, and go live with no coding required. Just create a free Fun Forms account to start supporting clients online.

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