About this template
A comprehensive health coach client intake form is essential for understanding a new client's background, wellness objectives, and medical history before beginning any coaching program. This template helps health and wellness professionals streamline their onboarding process by gathering critical personal information, emergency contacts, current health statistics, lifestyle habits, and specific coaching goals in an organized digital format.
By collecting this detailed background upfront, practitioners can tailor their sessions, identify potential health considerations, and set realistic, actionable goals with their clients. Designed for clarity, this template covers everything from baseline biometric data to stress management techniques and daily habits. With Doc2Form, you can easily deploy this template to collect structured client submissions directly into Google Sheets, ensuring your coaching practice starts on the right foot without messy paperwork.
Key features
- Capture complete personal and emergency contact details in one place
- Collect vital health history, allergies, and current medications
- Understand client lifestyle habits, stress levels, and daily routines
- Define clear expectations, life goals, and desired coaching outcomes
- Organized into logical sections for a smooth respondent experience
Use cases
Initial onboarding for new one-on-one health and wellness coaching cl…
Initial onboarding for new one-on-one health and wellness coaching clients
Gathering pre-session medical history and lifestyle data for fitness …
Gathering pre-session medical history and lifestyle data for fitness trainers
Assessing nutritional habits and wellness objectives before dietary c…
Assessing nutritional habits and wellness objectives before dietary consultations
Collecting digital consent and client intake details for remote welln…
Collecting digital consent and client intake details for remote wellness programs
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Select your date of birth.
- Gender (Dropdown)Select your gender identity.
- Phone Number (Short answer)Enter your primary contact number.
- Email Address (Short answer)Enter your preferred email for scheduling and resources.
- Residential Address (Paragraph)Enter your street address, city, state, and zip code.
- Occupation & Company Name (Short answer)What do you do for a living?
- Emergency Contact Name & Phone (Short answer)Provide the name and phone number of someone we can reach in case of an emergency.
- Height & Weight (Short answer)Provide your approximate height and weight.
- Blood Type (Dropdown)Select your blood type if known, or select 'Unknown'.
- Current Health Conditions (Paragraph)List any diagnosed medical conditions, chronic illnesses, or past injuries.
- Allergies (Paragraph)List any food, environmental, or medication allergies.
- Current Medications & Supplements (Paragraph)List any prescription medications, over-the-counter drugs, or supplements you take regularly.
- Primary Purpose for Working with a Health Coach (Paragraph)What inspired you to seek coaching at this time?
- Expected Outcomes From Coaching (Paragraph)What specific results do you hope to accomplish by the end of our program?
- Stress Management Methods (Paragraph)How do you currently handle daily stress?
- Sources of Happiness and Stress (Paragraph)Briefly describe what brings you joy in life, as well as your main daily stressors.
- Terms and Conditions Acceptance (Multiple choice)Please confirm that you understand health coaching is not a substitute for medical treatment.
- Digital Signature (Short answer)Type your full legal name to serve as your digital signature.
FAQ
What is a health coach client intake form?
It is a pre-session questionnaire used by health and wellness coaches to gather a client's personal details, medical history, lifestyle habits, and primary goals before starting coaching.
Can I customize the questions in this Google Form template?
Yes! Once you generate the form using Doc2Form, you have full control in Google Forms to add, remove, or edit any questions to fit your specific practice.
How do I share this intake form with my new clients?
You can easily share your form via a direct link, embed it on your coaching website, or send it automatically in your welcome email sequence.
Where are the client responses saved?
All submissions are securely collected and stored in your Google Drive account, with the option to automatically sync responses into a Google Sheet for easy tracking.
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.