What is the weight management intake form template?
Weight management works best when support is built around the person: their health, how and when they eat, how active they can be, what they've tried before and what they actually want to achieve. An intake form gathers that before the first session, so the conversation can start from where they are.
This template opens with contact details, height, current weight and an optional waist measurement. A health page covers conditions such as diabetes, high blood pressure, sleep apnoea, joint pain and PCOS — including a sensitive question about eating disorders, which shows a short supportive note when ticked — plus medicines, weight-loss medication or surgery, and pregnancy.
The eating and activity page asks about meals, habits, dietary needs, alcohol, activity, anything that limits movement, and sleep. The final page asks about weight history, past attempts, what matters most, a 3–6 month goal, readiness and confidence on 1–10 scales, likely barriers and the support they'd like. Each intake is saved as a PDF in FileIt.
- Best for
- Weight management services, dietitians, GP practices, health coaches and wellness programmes
- Filled in by
- The person joining the programme
- Time to complete
- About 8 minutes
- Includes
- Health conditions and medications, eating and activity habits, past attempts, goals, readiness and confidence scales, support preferences and consent
Who uses a weight management intake form?
- Enrolling people in a community weight management programme
- A GP practice referring patients to a health coach
- Dietitians preparing for a first appointment
- Workplace wellness schemes offering weight support
- Pre-assessment before a medically supervised programme
- Online coaching services onboarding new clients
Questions on this weight management intake form
31 questions over 4 pages · includes conditional questions, multiple pages, consent checkbox, ratings.
1 About you
- Your name*
- Date of birth*
- Phone*
- Email*
- GP or family doctor
- Height*
- Current weight*
- Waist measurement, if known
2 Health
- Health conditions* Type 2 diabetes · Prediabetes · High blood pressure · High cholesterol · Heart disease · Sleep apnoea · Joint pain or arthritis · PCOS · Thyroid condition · Depression or anxiety · An eating disorder, now or in the past · None of these
- Medicines you take
- Have you used weight-loss medication?* Yes, I take it now · Yes, in the past · No
- Which one, and for how long? asked only when it applies
- Have you had weight-loss surgery?
- Are you pregnant, breastfeeding or planning a pregnancy?* Yes · No · Not applicable
3 Eating & activity
- Meals a day, usually 1 · 2 · 3 · 4 or more · It varies a lot
- Which of these sound like you? I often skip breakfast · I snack in the evening · Takeaway or eating out 3+ times a week · Sugary drinks most days · Large portions · I eat when stressed, sad or bored · I eat during the night · I eat quickly
- Dietary needs Vegetarian · Vegan · Halal · Kosher · Gluten-free · Dairy-free · Food allergy
- Alcohol None · Occasionally · A few drinks a week · Most days
- Days a week you're active for 30 minutes or more* None · 1–2 · 3–4 · 5 or more
- What activity do you enjoy, or would like to try?
- Anything that limits how active you can be?
- Sleep on a typical night Less than 5 hours · 5–6 hours · 7–8 hours · More than 8 hours
4 Goals & readiness
- Your weight over the years
- What have you tried before? A diet plan · A slimming group · An app or calorie counting · An exercise programme · Meal replacements · Medication · A dietitian
- What matters most to you?* Losing weight · Better blood sugar · Lower blood pressure · More energy · Moving more easily · Feeling more confident · A better relationship with food
- A goal you'd like to reach in 3–6 months
- How ready are you to make changes now?*
- How confident are you that you can keep changes going?*
- What might get in the way?
- Support you'd like* One-to-one sessions · Group sessions · Online or app-based · Meal plans and recipes · Exercise sessions · Help with emotional eating
- Consent*
The weight management intake form, page by page
1 About you
The person gives their name, date of birth, phone, email and GP, then their height and current weight in whatever units they use, and their waist measurement if they know it.
2 Health
A checklist covers type 2 diabetes, prediabetes, high blood pressure, high cholesterol, heart disease, sleep apnoea, joint pain, PCOS, thyroid conditions, depression or anxiety, and eating disorders now or in the past — ticking that one shows a short note that the clinician will discuss the right support first. The page also asks about medicines, current or past weight-loss medication, weight-loss surgery, and pregnancy, breastfeeding or plans for a pregnancy.
3 Eating & activity
The person says how many meals they usually eat, ticks habits that sound like them — skipping breakfast, evening snacking, takeaways, sugary drinks, large portions, emotional or night eating — and their dietary needs. They then cover alcohol, how many days a week they're active for 30 minutes, the activities they enjoy, anything that limits activity and how much they sleep.
4 Goals & readiness
The final page covers weight history and what they've tried before, what matters most to them — from weight loss to blood sugar, energy, mobility or their relationship with food — and a goal for the next 3–6 months. Two 1–10 scales capture readiness and confidence, followed by likely barriers, the support they'd like and their consent.
Make the template yours
- Add a body measurement page if your programme records more than height and weight
- Change the support options to the sessions your programme runs
- Add eligibility questions if your service has referral criteria
- Route answers that mention an eating disorder to a clinician for review
- Prefill the referring practice with personal links
- Add your privacy notice to the consent statement
Tips for a better weight management intake form
- Use respectful, person-first language in follow-up conversations
- Review medicines before recommending changes in diet or activity
- Use the readiness score to pace the plan, not to judge
- Build the first goal from what the person said matters most to them
- Check limitations before suggesting exercise
- Treat past attempts as useful information about what to try next
Every response becomes a PDF in your vault
Each intake is saved as a PDF in the vault folder you choose, and the account owner can be emailed when someone enrols. The person can receive a copy of their answers.
In Responses, filter by date to see new enrolments, or export to CSV to see common goals and preferred types of support across your programme.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Weight management intake form: frequently asked questions
Is this weight management intake template free?
Yes. It's part of the Forms app, included with every FileIt account, the free plan too.
Does the form calculate BMI?
No. It records height and weight as the person enters them. Your clinician or coach can calculate BMI or other measures if your programme uses them.
Why is there a question about eating disorders?
Some weight management approaches aren't suitable for people with a past or current eating disorder. Ticking it shows a supportive note and flags it so a clinician can talk about the right support first.
Can people use their own units?
Yes. Height and weight are free text, so people can enter centimetres and kilograms or feet, stones and pounds.
Can I change the support options?
Yes. Edit the options in the designer to match what your programme offers.
Who can see the answers?
Responses are filed in your FileIt vault. Keep them in a folder only your team can open.