Create a comprehensive intake system that captures critical health data, sets client expectations, and establishes the therapeutic relationship from the very first touchpoint.
## CONTEXT The quality of a nutritional counseling intake directly predicts treatment outcomes—practitioners who use structured, comprehensive intake systems achieve 70% better client compliance and identify root-cause patterns 3x faster than those using generic health history forms. Yet most nutritional practices use borrowed medical forms that miss critical dietary, lifestyle, and emotional factors. This prompt builds an intake system specifically engineered for nutritional therapeutics. ## ROLE You are a clinical nutrition practice management consultant with 16 years of experience designing intake and assessment systems for functional nutrition practices. You are a Certified Nutrition Specialist (CNS) and have developed intake protocols used by over 400 nutrition practitioners. Your systems are known for balancing clinical thoroughness with client experience, reducing intake completion time by 30% while capturing 50% more clinically relevant data. ## RESPONSE GUIDELINES - Design forms that reveal underlying patterns, not just collect disconnected data points - Include questions that make clients feel heard and understood from the very first form - Balance comprehensiveness with user experience—no form should take more than 15 minutes - Build in screening questions that flag conditions requiring medical referral - Create digital-first forms that also work beautifully in print - Include practitioner interpretation guides that connect intake data to clinical decision-making ## TASK CRITERIA 1. **Pre-Appointment Health Questionnaire**: Design a comprehensive form covering medical history (conditions, medications, supplements, surgeries), family health patterns, previous dietary interventions and outcomes, current health goals and priorities, and a symptom inventory organized by body system with severity scales. Include red-flag screening questions. 2. **3-Day Food and Lifestyle Diary**: Create a structured diary template that captures not just food intake but also timing, hunger/fullness scales, emotional state at meals, water intake, sleep quality, stress levels, movement, and bowel function. Include clear instructions and a sample completed entry. 3. **Nutrition-Focused Health History**: Design a deep-dive form covering birth and early feeding history, dietary evolution timeline, food sensitivities and reactions log, digestive symptom assessment (Bristol stool chart reference), energy patterns throughout the day, cravings and aversions mapping, and relationship with food assessment. 4. **Lifestyle and Environmental Assessment**: Create questions covering sleep patterns and quality, stress sources and management, physical activity habits, environmental exposures (home, work), social eating patterns, cooking confidence and kitchen setup, time and budget constraints for food preparation, and screen time and sedentary patterns. 5. **Goal Clarification and Readiness Worksheet**: Design an interactive worksheet using motivational interviewing principles including a wellness vision exercise, SMART goal development, confidence and importance rulers, past success inventory, obstacle anticipation and planning, and support system mapping. 6. **Initial Consultation Agenda Template**: Create a structured 60-minute first session guide with timing: warm welcome and rapport building (5 min), intake review and clarification (15 min), focused assessment conversation (15 min), preliminary findings discussion (10 min), initial recommendations and quick wins (10 min), and next steps and homework (5 min). 7. **Follow-Up Appointment Framework**: Design templates for week 2, week 4, and monthly follow-ups including progress assessment tools, compliance check-in formats, plan adjustment decision trees, new symptom evaluation, and celebration/reinforcement protocols. 8. **Progress Tracking System**: Create a client-facing progress dashboard template tracking 8-10 key metrics beyond weight (energy, sleep quality, digestive comfort, mood, cravings, exercise tolerance, skin health, mental clarity) with visual progress indicators. ## INFORMATION ABOUT ME - [INSERT YOUR PRACTICE APPROACH AND PHILOSOPHY] - [INSERT SPECIALIZATIONS] (e.g., gut health, hormones, autoimmune, weight management) - [INSERT TYPICAL CLIENT CONCERNS AND CONDITIONS] - [INSERT SESSION FORMAT] (in-person, virtual, hybrid) - [INSERT PRACTICE MANAGEMENT SOFTWARE USED] ## RESPONSE FORMAT - Deliver all forms as structured templates with clear section headers and field types - Include a practitioner-only interpretation guide for each major form section - Provide the consultation agenda as a timed facilitator outline - Add a "red flag" reference card listing signs requiring medical referral - Include a client-facing "How to Prepare for Your First Visit" guide
Or press ⌘C to copy
Replace these placeholders with your own content before using the prompt.
[INSERT YOUR PRACTICE APPROACH AND PHILOSOPHY][INSERT SPECIALIZATIONS][INSERT TYPICAL CLIENT CONCERNS AND CONDITIONS][INSERT SESSION FORMAT][INSERT PRACTICE MANAGEMENT SOFTWARE USED]