About this template
A Nutrition and Wellness Intake Form is essential for dietitians, nutritionists, personal trainers, and wellness coaches who need a thorough understanding of a new client's health background, dietary habits, and lifestyle before starting a program. This comprehensive questionnaire helps practitioners gather critical details including personal and family medical history, current medications, supplement use, daily food intake, sleep patterns, and specific wellness goals.
Using Doc2Form, you can instantly turn this structured intake process into a convenient Google Form that clients can complete on any device before their initial consultation. Capturing this data in advance saves valuable session time, eliminates messy paper questionnaires, and ensures you have all the necessary information to design safe, personalized nutrition and lifestyle plans. Whether you run a private nutrition practice, a corporate wellness program, or a weight management clinic, this template streamlines your onboarding workflow and helps you deliver exceptional client care from day one.
Key features
- Collect complete health and medical history securely in one place.
- Understand daily food intake, sleep patterns, and exercise habits.
- Pinpoint specific client wellness goals and motivating factors.
- Streamline new client onboarding before the first consultation.
Use cases
Private practice dietitians onboarding new nutrition counselling clie…
Private practice dietitians onboarding new nutrition counselling clients.
Wellness coaches and fitness trainers assessing new program participa…
Wellness coaches and fitness trainers assessing new program participants.
Corporate wellness initiatives tracking employee health goals and hab…
Corporate wellness initiatives tracking employee health goals and habits.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Preferred Name (Short answer)What would you like us to call you during our sessions?
- Email Address (Short answer)We will use this to send appointment details and program materials.
- Phone Number (Short answer)Enter your primary contact number.
- Date of Birth (Date)Format: MM/DD/YYYY
- Occupation / Job Title (Short answer)Let us know what you do for a living, as this can impact your daily routine and stress levels.
- Current Medical Conditions (Paragraph)List any diagnosed medical conditions you currently manage.
- Current Medications and Supplements (Paragraph)List any prescription medications, over-the-counter drugs, vitamins, or herbal supplements you take regularly.
- Known Food Allergies or Sensitivities (Paragraph)List any foods you must avoid (e.g., peanuts, gluten, dairy, shellfish).
- Describe Your Typical 24-Hour Food Intake (Paragraph)Briefly list what you typically eat and drink in a normal day (meals, snacks, beverages).
- Sleep Quality and Average Hours (Short answer)How many hours of sleep do you get per night, and how would you rate its quality?
- Exercise Frequency (Multiple choice)How often do you engage in physical activity or structured exercise each week?
- Alcohol Consumption (Dropdown)Select your typical frequency of alcohol consumption.
- Tobacco or Nicotine Use (Multiple choice)Do you currently use tobacco or nicotine products?
- Primary Wellness Goals (Checkboxes)Select your top priorities for working together.
- What is your main motivation for seeking guidance right now? (Paragraph)Share your 'why' — what prompted you to start this journey?
- Personal Wellness Scale (Linear scale)How would you rate your overall health and well-being currently?
- Supporting Document Upload (Paragraph)Please paste a link to any relevant lab results or food logs (Google Drive, Dropbox, etc.) or describe them here.
- Terms and Conditions Acceptance (Multiple choice)By submitting this form, you confirm that the information provided is accurate to the best of your knowledge and consent to participate in wellness coaching.
FAQ
What is the main purpose of this intake form?
It allows wellness professionals and dietitians to collect vital health history, dietary habits, lifestyle details, and personal goals from new clients prior to their first session.
Can I customize the questions for my specific practice?
Yes! Once you generate your form using Doc2Form, it lives in your Google Drive, giving you full freedom to add, remove, or edit any questions to match your practice's needs.
How do my clients fill out this form?
You can share the Google Form link via email, text, or embed it directly on your website. It works seamlessly on mobile phones, tablets, and desktop computers.
Where is the submitted client data stored?
All responses are automatically saved in a Google Sheet linked to your form, making it easy to review client details, organize notes, and track progress over time.
Is Doc2Form free to use?
Yes, you can quickly convert documents and templates into fully functional Google Forms using Doc2Form.
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.