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DIET HISTORY FORM Nutrition Support Service Veterinary Medical Teaching Hospital University of California, Davis FAX: (530) 7527901 DATE: REASON FOR TODAYS VISIT:WEIGHT (lb.):& CurrentIdealBODY CONDITION
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How to fill out diet history form

01
Start by writing your personal information like your name, age, gender, and contact details.
02
Next, record your current weight and height.
03
Fill in details about your medical history, including any existing conditions or allergies.
04
Mention any medications or supplements you are currently taking.
05
Provide information about your typical daily food intake, including meals, snacks, and beverages.
06
Be as detailed as possible when listing the types of food you consume and the portion sizes.
07
Include information about any special diets or restrictions you follow, such as vegetarian or gluten-free.
08
Mention any food intolerances or sensitivities you may have.
09
Record any physical activity or exercise routines you engage in regularly.
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Finally, sign and date the form to complete the diet history record.

Who needs diet history form?

01
Diet history forms are usually required by healthcare professionals, nutritionists, or dieticians.
02
Individuals seeking nutritional advice or wanting to track their dietary habits can also benefit from filling out a diet history form.
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It provides valuable information for assessing nutritional needs, identifying dietary patterns, and making personalized recommendations.
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Diet history form is a document used to gather information about a person's dietary habits and history.
Individuals who are undergoing medical treatment or participating in a nutrition program may be required to file a diet history form.
To fill out a diet history form, one must provide detailed information about their daily food and beverage consumption, any dietary restrictions or preferences, and relevant medical history.
The purpose of a diet history form is to help healthcare providers assess an individual's nutritional status, identify areas for improvement, and tailor nutritional recommendations.
Information such as daily food and beverage consumption, dietary restrictions, preferences, and relevant medical history must be reported on a diet history form.
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