formisoft

Nutritional Assessment Form

Asks about current weight, height, and BMI calculation. Built for inpatient malnutrition screening upon hospital admission.

Questions
14
Pages
2
Time
about 4 min

Includes

  • Allergy list
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Your practice

Nutritional Assessment Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Inpatient malnutrition screening upon hospital admission
  • Outpatient dietary counseling and wellness visits
  • Geriatric nutritional risk assessment in long-term care
  • Oncology nutrition evaluation during treatment planning

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What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Patient NameText · Required
  2. Date of BirthDate
  3. Current WeightNumber
  4. HeightNumber
  5. BMI CalculationNumber

Page 2 · Additional details

  1. Daily Meal FrequencyLong Text
  2. Food AllergiesAllergies
  3. Appetite ChangesLong Text
  4. Current SupplementsLong Text
  5. 24-Hour Dietary RecallLong Text

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Nutritional Assessment Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 14 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Nutritional Assessment Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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