About this template
Designed specifically for holistic healers, wellness coaches, and alternative medicine practitioners, this client intake form streamlines your onboarding process. Gathering comprehensive background information before a first session is essential for tailoring treatments that address medical, emotional, and spiritual well-being. This template captures vital client details including contact information, primary health concerns, current medical support, sleep patterns, stress levels, and specific wellness goals.
By collecting these insights ahead of time, practitioners can arrive at initial consultations fully prepared, allowing for a deeper, more focused healing session. Clients appreciate the opportunity to thoughtfully share their history and recent emotional or physical challenges without feeling rushed in the treatment room. With Doc2Form, you can instantly convert this template into a ready-to-use Google Form, customize fields to match your specific practice, and seamlessly integrate responses into your workflow.
Key features
- Capture complete client health history and wellness goals in one organized step.
- Assess current stress levels, sleep quality, and lifestyle factors easily.
- Provide clients a thoughtful space to outline emotional and spiritual intentions.
- Collect digital file uploads or document links for previous medical records.
- Streamline new client onboarding for holistic clinics and independent practices.
Use cases
Initial intake for new holistic health coaching clients.
Pre-session questionnaire for energy healing or bodywork appointments.
Onboarding participants for multi-week holistic wellness programs.
Collecting background health data for alternative medicine consultati…
Collecting background health data for alternative medicine consultations.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Phone Number (Short answer)Include your area code.
- Email Address (Short answer)We will use this to send session prep materials and appointment reminders.
- Mailing Address (Paragraph)Street address, city, state, and zip code.
- Date of Birth (Date)Please enter your date of birth.
- Age (Short answer)Enter your current age.
- Main Health Concerns (Paragraph)Describe the primary physical, emotional, or spiritual issues you hope to address.
- Wellness & Healing Goals (Paragraph)What do you most hope to achieve through our sessions together?
- Medical History Summary (Paragraph)List any major past diagnoses, surgeries, or chronic conditions.
- Current Healthcare Support (Paragraph)Are you currently seeing other practitioners (e.g., PCP, chiropractor, therapist, acupuncturist)?
- Sleep Quality & Duration (Paragraph)How many hours do you sleep on average, and how would you rate your sleep quality?
- Current Stress Levels (Linear scale)Rate your overall daily stress level on a scale from 1 to 5.
- Recent Emotional Well-being (Paragraph)Summarize how you have been feeling over the last 3 months emotionally.
- Supporting Files Upload (Paragraph)Please paste a link to your file (Google Drive, Dropbox, etc.) or describe any relevant medical documents you wish to share.
- How did you hear about us? (Dropdown)Select the option that best describes how you found our practice.
FAQ
How do I customize this form for my specific practice?
Once you convert the template using Doc2Form, you can freely edit, add, or remove any questions directly within Google Forms to fit your modalities.
Can clients upload previous medical records or lab results?
Yes. The form includes a dedicated prompt where clients can paste links to relevant documents stored in Google Drive, Dropbox, or other cloud storage.
Is this form suitable for remote or telehealth sessions?
Absolutely. It is fully digital, making it easy to email to clients ahead of virtual consultations so you can review their details beforehand.
How do I share this intake form with my clients?
You can share the Google Form via a direct link, embed it on your website, or automatically include it in your booking confirmation emails.
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.