About this template
The Client Health Questionnaire Google Form template is designed for doctors, therapists, counselors, and wellness practitioners to gather comprehensive health and lifestyle data from clients before appointments. This essential intake tool streamlines patient onboarding by systematically collecting critical information, including general medical background, symptom assessments like the PHQ-9 and GAD-7, alcohol and substance use history, and treatment backgrounds.
Gathering accurate health histories digitally eliminates the friction of paper clipboards, reduces administrative errors, and allows providers to review crucial clinical data before stepping into a session. Whether you operate an in-person clinic or offer virtual telehealth services, this questionnaire ensures you have complete, organized records right inside your Google Workspace. With Doc2Form, you can instantly turn this template into a live, ready-to-use form and start capturing secure client responses in minutes.
Key features
- Standardized screening sections for mental health and lifestyle habits
- Pre-session intake to save time during clinical consultations
- Fully customizable questions to match your specific practice needs
- Seamless integration with Google Sheets for organized record-keeping
- Accessible on any device for convenient remote completion
Use cases
- New patient onboarding for private medical or counseling practices
- Telehealth pre-appointment mental health and wellness screening
- Initial clinical intake for rehabilitation and wellness centers
- Periodic health and lifestyle check-ins for ongoing clients
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Select your date of birth.
- PHQ-9 Symptom Frequency (Multiple choice)Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things?
- GAD-7 Symptom Frequency (Multiple choice)Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or on edge?
- Alcohol Consumption (AUDIT) (Dropdown)How often do you have a drink containing alcohol?
- Alcohol Treatment History (Multiple choice)Have you ever received treatment or support for alcohol use?
- Past-Year Drug Use Status (Multiple choice)Have you used any recreational drugs or prescription medications for non-medical reasons in the past 12 months?
- Substances Used (Past Year) (Checkboxes)Select all substances used in the past year, if applicable.
- Substance Abuse Treatment History (Multiple choice)Have you ever participated in a substance abuse treatment program or recovery support group?
- Additional Health Notes (Paragraph)Please share any other medical conditions, current medications, or concerns you would like your practitioner to know.
FAQ
How do I use this health questionnaire template with my clients?
Simply click to generate your own editable copy using Doc2Form. You can then share the form link with clients via email or embed it in your client portal before their appointment.
What kind of health data does this questionnaire collect?
The form gathers contact details, medical history, symptom frequencies, and lifestyle information such as substance usage and treatment background, providing a holistic overview of client well-being.
Can I customize the questions to fit my specific clinical focus?
Yes! Once the form is in your Google account, you can freely edit, add, or remove any questions to align with your practice's requirements.
Where are the questionnaire responses saved?
All submissions are automatically stored in your Google account and can be linked to a Google Sheet for easy tracking and review.
Is this form suitable for telehealth and remote appointments?
Absolutely. Online intake forms are ideal for virtual practices, allowing clients to complete their health histories comfortably from home before a video consultation.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.