Pre-Dietetics Appointment Form
This form helps Tess prepare for your consultation. It takes about 8 minutes and your answers are saved to your patient file. Under each question we've explained why we're asking, so you can see how the information gets used. Anything you'd rather not write down can be discussed in the consultation instead.
So we can match this form to your booking and your patient file.
This is where your summary or meal plan will be sent after your consultation.
Nutrition needs shift across the lifespan, and this confirms we're working from the right patient record.
Food and nutrition sit alongside the rest of your health, so Tess needs a picture of what else is going on before she can give you advice that's safe for you specifically.
Tess writes back to your GP after your consultation so your care stays joined up. If your appointment is funded through Medicare, that report is a requirement of the referral rather than a courtesy.
So the report reaches the right practice.
Diagnoses or health conditions
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Conditions such as diabetes, coeliac disease, kidney disease, reflux and thyroid conditions all change what Tess can safely recommend. Something that suits one person can be the wrong advice for another.
Current medications and supplements
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Some medications change appetite, taste, blood sugar or how well you absorb particular nutrients. Supplements matter for the same reason. More is not always better, and a few interact with common medications, so Tess needs the full picture rather than half of it.
Allergies and food intolerances
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So nothing Tess suggests puts you at risk, and so she can account for anything you have already had to leave out and check you're not missing nutrients because of it.
This one is optional, and we'd rather you booked without it than delayed getting started. Here's why we ask anyway. Bloods show Tess things that can't be seen from the outside, like iron, B12, vitamin D, blood sugar, cholesterol, kidney and liver function. Low iron or B12 can explain fatigue that looks like a diet problem but isn't. Blood sugar and cholesterol results change what she'd prioritise. Without them she works from what you tell her, which is still useful, it just means some of the first consultation goes on guesswork that a set of results would have answered in a minute.
Do you have blood test results from the last 12 months?
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Do you authorise Continuum to request your results or a brief health summary from your GP if needed?
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This lets us fill any gaps without you having to chase paperwork. You can say no, and it won't affect your care.
None of this is a test and there are no wrong answers. Tess needs to understand how you actually eat and live before she can suggest anything that will work for you.
What would you like to work on?
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This tells Tess where to start, so your first consultation is spent on what actually matters to you. Tick as many as apply.
Gut symptoms are common, often diet related, and frequently go unmentioned because people assume they're just normal for them. Naming them here means Tess can start working on them from the first consultation.
Have there been recent changes to your appetite or eating?
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Changes in either direction can point to something worth looking at. It also helps Tess understand what's been happening for you lately, rather than only where things sit today.
Any cultural, religious or personal food requirements?
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So your plan works with the way you eat rather than against it.
What would you like to get out of working with Tess?
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Your goals shape the consultation more than anything else on this form.
Is there anything that would help you feel comfortable in the consultation?
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Telling us now means Tess can set the consultation up the way you need it, rather than you having to ask in the moment.
