Irvine, CA · Orange County
Nutrition Risk Assessment
This assessment records nutrition-related risks and meal-service needs for clients completing a Community Services Senior Services assessment.
What this form is
The Nutrition Risk Assessment records answers about eating habits, health conditions, food access, medications, and ability to shop, cook, and eat. It calculates a nutritional risk score and asks about fluid intake, dietary restrictions, and kitchen equipment. The form includes fields for the client’s name and date, plus an office-use section; the document does not state when the city requires it.
Who needs it
Clients completing this Community Services Senior Services assessment answer the nutrition questions and provide information about meal preparation and kitchen equipment.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This form has no notary block; it asks for the client’s name and date, and the text mentions no notarized attachment or related step.
How to submit this form
- 1
Download The Form
Download the Nutrition Risk Assessment PDF.
- 2
Complete The Assessment
Answer the nutrition and meal-related questions and fill in the client name and date.
- 3
Check For Attachments
The form text does not identify any attachments to gather.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Nutrition Risk Assessment ask?
- It asks about eating habits, health conditions, food access, medications, physical ability, fluids, dietary restrictions, and kitchen equipment.
- Who completes this assessment?
- The form is for clients completing a Community Services Senior Services assessment. It includes fields for the client’s name and date.
- Do I need a notary for the Nutrition Risk Assessment?
- No. This form has no notary block; it asks for the client’s name and date, and the text mentions no notarized attachment or related step.
- How do I submit the Nutrition Risk Assessment?
- The form does not provide submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Nutrition Risk Assessment doesn’t need a notary — but if you have another Irvine form that does, a commissioned online notary can help.