This short screening is based on the MUST (Malnutrition Universal Screening Tool), the Patients Association Nutrition Checklist and GLIM (Global Leadership Initiative on Malnutrition) criteria. It takes around 5–8 minutes and gives you personalised nutritional advice to share with your GP or care team.
Why this matters
Eating well is important at every stage of life. Changes to your appetite or food intake can sometimes affect your health. Identifying these changes early and getting the right support can make a real difference to how you feel and recover.
📋
Sections
5 areas
⏱️
Time
5–8 minutes
🔒
Privacy
No identifiable data stored
🩺
Based on
MUST, PANC & GLIM
Who is completing this form?
This tool is for information only and does not replace advice from a healthcare professional.
Section 1 of 7 — Your Measurements
Your nutritional needs
Estimates are fine — these help us calculate your nutritional requirements. You can skip this section if you prefer.
Biological sex
What is your biological sex?
This helps us calculate your nutritional requirements accurately.
Age
How old are you?
This helps us calculate your fluid requirements.
Optional — leave blank if you prefer not to say
Weight and height
Do you know your approximate weight?
Usual weight
That's fine. Can you tell us your usual adult weight — the weight you've been most of your adult life?
This helps us estimate your nutritional requirements. Leave blank if you're not sure.
Have you lost weight recently?
Roughly how much weight have you lost?
Over roughly what period of time?
Over the past 3–6 months, has your weight been…
Measurements
Weight
Height
Weight change
Have you lost weight recently?
Amount of weight loss
How much weight have you lost?
An estimate is fine.
Timeframe
Over roughly what period of time?
Recent weight trend
Over the past 3–6 months, has your weight been…
Section 2 of 7 — Screening
A few screening questions
Answer as honestly as you can. There are no right or wrong answers.
Nutritional concern
Are you or your family concerned that you may be underweight or need nutritional advice?
Weight loss
Have you lost a lot of weight unintentionally in the past 3 months?
Clothing and fit
Have you noticed that your clothes or rings have become loose recently?
Appetite
Have you recently found that you have lost your appetite and/or interest in eating?
🟡 Based on your answer, you may be at nutritional risk. We will ask you a few more questions to find out how best to support you.
🟢 Based on your answers, you do not appear to be at nutritional risk right now. We will still ask a few questions about your health and eating habits.
Section 3 of 7 — Clinical Questions
A few clinical questions
Tick everything that applies to you. Leave unticked if it doesn't apply.
Medical conditions
Do any of these apply to you?
✓
I am under the care of a kidney consultant due to reduced kidney function (eGFR less than 30 mls/min)
✓
I have diabetes
✓
I have had previous stomach or bowel surgery, including bariatric surgery
✓
I currently have pressure sores or open wounds, or I am recovering from surgery
✓
I have a history of alcohol or drug dependency
✓
I have been diagnosed with cancer, or am currently receiving cancer treatment (including chemotherapy, radiotherapy or immunotherapy)
✓
I have a condition that affects how my body absorbs food (e.g. Crohn's disease, coeliac disease, chronic pancreatitis)
✓
I am actively experiencing a difficult relationship with food or eating
✓
None of the above
Diabetes — blood glucose control
Has your average blood glucose level (HbA1c) been checked in the past 3 months?
Your GP or diabetes team will have told you this result.
Symptoms
Have you noticed any of these symptoms recently?
These can sometimes be a sign that further investigation could be useful. Tick all that apply.
✓
Extreme thirst
✓
Needing to pass urine more often than usual
✓
Blurred vision
✓
Slow wound healing
✓
Frequent bladder infections or thrush
✓
Tingling or pins and needles
✓
None of the above
Clinical advice
Have you been advised by your clinical team to do any of the following?
✓
Use thickened fluids (advised by a speech and language therapist)
✓
Follow a low fibre or low residue diet
✓
Follow a low fat diet
✓
None of the above
Nutritional supplement drinks
Are you currently taking oral nutritional supplement drinks (e.g. Fortisip, Ensure, Complan prescribed or recommended by a health professional)?
Nutritional supplement drinks — recommended by
Who recommended or prescribed your supplement drinks?
Nutritional supplement drinks — tolerance
Are you managing to take them as recommended?
Section 4 of 7 — Current Food Intake
How much are you eating?
This helps us understand your current nutritional intake and identify any immediate concerns.
Current intake
What is your current food intake like?
Section 5 of 7 — Barriers to Eating
What gets in the way of eating well?
These questions help us understand what support you need. Tick everything that applies to you.
Preparing meals
Does anything stop you from being able to make your own meals, drinks and snacks regularly?
Tick all that apply
✓
Pain — regularly during the day
✓
Mobility problems — unable to stand long enough to prepare food
✓
Dexterity problems — difficulty using kitchen utensils, cutting food or using the oven safely
✓
Fatigue and weakness — too tired or weak to prepare own meals regularly
✓
Muscle weakness or loss — difficulty gripping, lifting, or getting up from a chair
✓
Frequently breathless, even at rest — making it difficult to eat or prepare food
✓
Low mood — difficulty motivating myself to prepare meals
✓
None of the above
Stomach and digestive problems
Do you frequently (most days) experience any of the following?
✓
Loss of appetite or feeling full too quickly
✓
Nausea or vomiting
✓
Constipation — hard stools that are difficult to pass
✓
Diarrhoea — loose or watery stools, opening bowels more frequently than normal
✓
Bloating
✓
Reflux or heartburn
✓
None of the above
New medications
Have you started any new medications recently?
Some medicines can affect appetite. Your GP may be able to help.
Mouth and taste problems
Do you frequently experience any of the following?
✓
Dental pain or dentures that don't fit well
✓
Dry mouth
✓
Sore mouth
✓
Taste changes — including no taste or unpleasant tastes
✓
Swallowing difficulties, coughing after eating or drinking, or food getting stuck
✓
None of the above
Food access and affordability
Do any of the following apply to you?
✓
I find it difficult to buy food because of money issues
✓
I don't live close to a shop that sells a good range of food I like
✓
I struggle to get to my local shop and I can't order food online
✓
I do not have control over my own money and cannot buy the things I need
✓
None of the above
Section 6 of 7 — Support & Shopping
Getting support with food
These questions help us understand whether you have enough support with meals.
Preparing meals at home
How are you managing with preparing meals, drinks and snacks at home?
Food shopping
How are you managing with food shopping?
Local support options
Would you like information about local support options available for meal preparation and/or food shopping?
Your aim
What would you most like to achieve over the next 1–2 months?
Choose the one that feels most important to you right now.
Section 7 of 7 — Eating Advice & Consent
Personalising your advice
A few final questions to make sure your advice is right for you.
Your Results
Your personalised summary
Your full personalised nutrition advice — keep this for your records.
A clinical summary to share with your GP or care team.
How to share this with your GP
1
Add your details below — enter your name, date of birth and GP surgery so the summary can be matched to your record. This is optional but helpful.
2
Save or print the summary — click Print or save as PDF below. In the print menu, choose Save as PDF to save a copy to your device, or select your printer to print a paper copy.
3
Share it with your GP surgery — you can either:
📧 Email it — click Email to GP surgery below and send the pre-filled email, or attach your saved PDF to an email to your surgery
🖨️ Print and hand it in — bring the printed copy to your next appointment or drop it in to the surgery
Patient details (optional — not stored by NourishCheck)
Add these so the summary can be matched to the correct patient record. They will appear at the top of the GP summary below.
This will open your email app with the summary pre-filled. You can check and edit it before sending.
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Patient or carer feedback
If you are a patient or a family member / carer who has completed this form, please use this link: