About this template
Gathering comprehensive health history and lifestyle details is essential for any effective wellness practice. This Health Client Information Google Form template streamlines onboarding by capturing critical patient data—including primary health concerns, symptom checklists, current medications, daily nutrition, sleep habits, and exercise routines—before your initial consultation.
Designed specifically for health coaches, nutritionists, and holistic practitioners, this template eliminates messy paper intake packets and organizes client responses directly into Google Sheets. By collecting detailed background information in advance, you can make the most of your first face-to-face session, tailoring personalized care plans without spending valuable appointment time on basic administrative questions.
Doc2Form makes it easy to deploy this template in seconds. Simply copy it to your Google Drive, customize the questions to fit your practice's specific focus, and share the link with new clients prior to their first visit for a seamless, professional intake experience.
Key features
- Collect detailed medical history and top health concerns before the first visit.
- Track daily habits, including nutrition, sleep, and exercise frequency.
- Organize symptom checklists and current medication lists automatically.
- Fully customizable to match your specific wellness practice or coaching style.
- Stores all client responses securely in Google Drive and Google Sheets.
Use cases
- Initial intake for new health coaching clients and nutritionists.
- Pre-appointment health history screening for holistic practitioners.
- Wellness baseline assessments for fitness and lifestyle programs.
- Remote patient intake for telehealth and virtual consultations.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Email Address (Short answer)Where we can reach you with scheduling and resources.
- Phone Number (Short answer)Best number for appointment reminders or urgent updates.
- Age (Short answer)Enter your current age in years.
- Primary Health Concern (Short answer)What is the main health or wellness issue you would like to address?
- Primary Concern Details & Goals (Paragraph)Describe how long this has been an issue and what specific goals you hope to achieve.
- Secondary Health Concern (Short answer)Do you have any secondary health concerns? (Optional)
- Secondary Concern Details & Goals (Paragraph)Provide brief details and goals for your secondary concern.
- Recent Symptom Checklist (Checkboxes)Select any symptoms you have experienced frequently over the past month.
- Prescribed Medications & Usage (Paragraph)List any prescription medications you currently take along with their dosage and frequency.
- Supplements, Herbs, or Vitamins (Paragraph)List any supplements you take and the reason you take them.
- Exercise Frequency & Duration (Short answer)How often do you exercise, and for how long per session?
- Exercise Types (Checkboxes)What kinds of physical activity do you regularly enjoy?
- Typical Daily Diet (Paragraph)Briefly describe what you typically eat for breakfast, lunch, and dinner.
- Food Cravings & Dietary Restrictions (Paragraph)Do you experience strong food cravings, or follow any specific diet or allergy restrictions?
- Sleep Habits (Short answer)How many hours of sleep do you average per night, and do you wake up feeling rested?
- Tobacco and Alcohol Use (Short answer)Describe your frequency of alcohol consumption and tobacco or nicotine use.
- Diet & Lifestyle Change Willingness (Linear scale)Rate your current readiness to make necessary changes to your diet and lifestyle.
- Household Support System (Multiple choice)Do you have support from family or household members for your health goals?
- Additional Pre-Appointment Notes (Paragraph)Share anything else you would like your practitioner to know before your session.
- How did you hear about us? (Dropdown)Select your referral source.
FAQ
How do I share this form with my clients?
Once you copy the template to your Google Account, simply click 'Send' to email the form link directly to clients or embed the link on your website's onboarding page.
Where is the client health data stored?
All submissions are saved directly to your secure Google Drive and can be linked to a Google Sheet for easy review prior to appointments.
Can I add or remove questions from this template?
Yes! Because it's a standard Google Form, you have full control to edit, add, or delete any questions to match your practice's specific needs.
Is this template free to use?
Yes, this template is completely free to copy and use via Doc2Form and Google Forms.
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.