About this template
A comprehensive health survey is an essential diagnostic and onboarding tool used by medical professionals, wellness practitioners, and health coaches to capture a complete picture of a client’s well-being. This template covers vital health metrics, medical history, dietary habits, sleep patterns, exercise routines, and stress levels in an organized, easy-to-read format.
Whether you run a private medical practice, a specialized wellness clinic, or work as an independent health coach, streamlining your intake process saves valuable time during consultations. Instead of sorting through unstructured notes, this standardized questionnaire ensures you collect every critical data point—from existing conditions and medications to daily water intake and sleep quality—before the appointment even begins.
Doc2Form lets you instantly convert this template into a ready-to-use Google Form, allowing you to share a secure link via email or your website. Clients can complete the survey on any device, and all responses automatically route to your Google Sheets for seamless tracking and patient management.
Key features
- Collect detailed medical history and lifestyle metrics in one step
- Standardize patient intake for accurate wellness planning
- Mobile-friendly format for easy completion on any device
- Automatic response organization in Google Sheets
- Fully customizable questions to match your practice's specific needs
Use cases
- Initial consultations for new health coaching clients
- Pre-appointment intake for medical practices and clinics
- Wellness program enrollment and baseline assessments
- Comprehensive lifestyle and dietary tracking for nutritionists
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Select your date of birth.
- Email Address (Short answer)Enter the best email address to reach you.
- Phone Number (Short answer)Enter your primary contact number.
- Gender (Multiple choice)Select how you identify.
- Existing Medical Conditions (Paragraph)List any chronic conditions, past surgeries, or ongoing health issues.
- Current Medications & Supplements (Paragraph)List any prescription medications, over-the-counter drugs, or vitamins you take regularly.
- Food Allergies & Dietary Restrictions (Paragraph)Describe any known food allergies, intolerances, or specific dietary preferences.
- Height & Current Weight (Short answer)Enter your approximate height and current weight.
- Average Sleep Hours (Dropdown)How many hours of sleep do you typically get per night?
- Sleep Quality (Linear scale)Rate your overall sleep quality.
- Daily Water Intake (Multiple choice)How much water do you drink daily?
- Weekly Exercise Frequency (Dropdown)How many times per week do you engage in intentional exercise?
- Exercise Types (Checkboxes)Select the types of physical activity you regularly enjoy.
- Daily Energy Level (Linear scale)Rate your average daily energy level.
- Overall Stress Level (Linear scale)Rate your current overall stress level.
- Smoking & Alcohol Status (Paragraph)Describe your smoking habits and weekly alcohol consumption.
- Primary Health & Wellness Goals (Paragraph)What are your main goals for working with us?
FAQ
Why is a health survey template used?
A health survey template collects comprehensive medical and lifestyle information from clients, including health history, current medications, diet, sleep, and stress levels. It provides practitioners with structured data to create personalized treatment or coaching plans.
What information should be included in a health survey?
It should include basic personal details, medical history, existing conditions, current medications, allergies, physical metrics like height and weight, and lifestyle factors such as sleep habits, nutrition, and exercise routines.
When should I send this survey to clients?
It is best sent immediately after booking an initial consultation or routine check-up, giving clients ample time to complete it before their appointment so you can review their history in advance.
Can I customize the questions in this template?
Yes. Once you convert this template into Google Forms using Doc2Form, you have full freedom to add, remove, or edit any questions to fit your specific practice requirements.
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.