About this template
Understanding a client's daily routine is the first step toward effective health coaching, personalized nutrition planning, and fitness guidance. This Healthy Habits Questionnaire provides a comprehensive overview of an individual's lifestyle, covering everything from meal frequency and hydration habits to exercise routines and personal health goals.
Designed for health coaches, personal trainers, nutritionists, and wellness program coordinators, this template streamlines the initial intake process. Instead of managing endless paper notes or disconnected emails, you can collect structured, standardized data straight into a Google Sheet. Respondents can easily complete the questionnaire on their phone or computer before a consultation, giving you valuable insights before your first meeting.
With Doc2Form, you can instantly convert, customize, and deploy this questionnaire in seconds. Add or remove questions to match your specific wellness philosophy, adjust formatting, and share the link with clients instantly to kickstart their health journey.
Key features
- Comprehensive coverage of daily nutrition, hydration, and meal pacing.
- Built-in tracking for exercise frequency and personal health goals.
- Mobile-friendly design for quick completion on smartphones or tablets.
- Instant data organization via Google Sheets integration.
- Fully customizable questions to fit your specific coaching framework.
Use cases
- Initial wellness consultations for new fitness coaching clients.
- Dietary assessments for registered dietitians and nutritionists.
- Corporate wellness program health risk and habit tracking.
- Physical education and student lifestyle assessments.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Phone Number (Short answer)Enter the best phone number to reach you for scheduling or follow-up.
- Age Range (Dropdown)Select your current age bracket.
- Gender Identity (Dropdown)Optional: Let us know how you identify.
- Breakfast Type (Paragraph)Describe what you typically eat for breakfast on a normal weekday.
- Breakfast Skipping Frequency (Multiple choice)How often do you skip breakfast?
- Pre-Lunch Hunger and Tiredness (Multiple choice)Do you often feel overly hungry or fatigued right before lunch?
- Lunch Type (Paragraph)What does a typical lunch look like for you?
- Average Meal Duration (Dropdown)How long do you typically spend eating a main meal?
- Chewing Habits (Multiple choice)How would you describe your chewing pace?
- Last Meal Timing (Dropdown)How many hours before bedtime do you usually eat your last meal?
- Eating Stopping Point (Multiple choice)When do you typically stop eating during a meal?
- After-Dinner Snacking Frequency (Multiple choice)How often do you snack after dinner?
- Non-Water Drink Choices (Checkboxes)What beverages do you regularly consume other than plain water? Select all that apply.
- Sweetener Preferences (Multiple choice)What kind of sweeteners do you usually use in your food or drinks?
- Exercise Frequency (Multiple choice)How often do you engage in intentional physical activity or workouts?
- Weight Perception (Multiple choice)How do you currently feel about your body weight?
- Primary Health and Wellness Goals (Checkboxes)What are your main goals for improving your health right now? Select all that apply.
- Additional Information Request (Multiple choice)Would you like to receive further resources or follow-up regarding your healthy habits?
FAQ
How do I share this questionnaire with my clients?
Once Doc2Form generates your Google Form, you can simply copy the sharing link and email it to clients, text it, or embed it directly on your website.
Can I edit the questions to match my coaching program?
Yes! Because the template lives in your Google Drive as a standard Google Form, you can add, remove, or reorder any questions at any time.
Where do the questionnaire responses go?
All submissions automatically populate a Google Sheet linked directly to your form, making it easy to review and analyze client data in one place.
Is this form suitable for remote telehealth consultations?
Absolutely. It is ideal for gathering pre-session data remotely so you can make the most of your live video consultations.
Can clients complete this form on their mobile phones?
Yes, Google Forms are fully responsive and work seamlessly on mobile devices without requiring any special app download.
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.