About this template
An Online Wellness Evaluation Form is an essential digital tool designed for health coaches, fitness professionals, and wellness clinics to capture comprehensive health profiles from new clients. Before starting any coaching program or fitness regimen, practitioners need a clear understanding of an individual's medical history, current lifestyle habits, nutritional intake, and specific well-being goals. This template covers everything from baseline biometric data and existing medical conditions to daily water intake, stress levels, and sleep patterns.
Using Doc2Form, you can instantly turn this structured evaluation into a ready-to-use Google Form, making client onboarding seamless and professional. Collecting this data upfront allows practitioners to tailor programs, identify potential health risks or physical limitations, and track client progress over time. Whether you run a private wellness practice, a boutique fitness studio, or an online coaching program, streamlining your client intake process ensures you have the insights needed to deliver personalized, safe, and effective guidance right from day one.
Key features
- Capture comprehensive health history and lifestyle habits in one streamlined submission
- Assess dietary routines, water intake, and stress levels for holistic program planning
- Identify primary wellness goals and target areas for improvement instantly
- Ask targeted questions about past medical conditions and recent procedures safely
- Deploy instantly to Google Forms with zero manual rebuilding required
Use cases
- New client onboarding for personal trainers and private health coaches
- Initial health assessments for holistic wellness centers and spas
- Intake documentation for corporate wellness challenge participants
- Pre-program health screening for remote fitness and nutrition programs
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Email Address (Short answer)Where we can send your evaluation summary and program details.
- Phone Number (Short answer)Include your country and area code.
- Mailing Address (Paragraph)Street address, city, state, and zip code.
- Birth Date (Date)Used to calculate age-appropriate wellness metrics.
- Gender (Multiple choice)Select the option you most closely identify with.
- Height & Weight (Short answer)Please provide your height (feet/inches) and current weight (pounds).
- Do you have any existing medical conditions? (Multiple choice)Select yes if you are currently managing any diagnosed health conditions.
- Existing Medical Conditions Details (Paragraph)If you answered yes above, please list your conditions and how they are currently managed.
- Are you currently taking any medications or supplements? (Multiple choice)Include prescription drugs, over-the-counter medications, vitamins, and herbal supplements.
- Medications or Supplements Details (Paragraph)Please list the name, dosage, and frequency of anything you take regularly.
- Have you had any recent surgeries or medical procedures? (Paragraph)List any operations or major medical interventions within the last 3 years.
- Health Conditions to Note (Checkboxes)Check any conditions that apply to you currently or in the past.
- Do you have any known food or environmental allergies? (Multiple choice)Include severe reactions, intolerances, or sensitivities.
- Allergies Details (Paragraph)Please describe your allergies and the nature of your reactions.
- Dietary Habits (Paragraph)Describe your typical daily diet, including any specific eating styles (e.g., vegan, keto, gluten-free).
- Current Exercise Routine (Paragraph)Describe what physical activity you currently do and how often per week.
- Sleep Patterns (Short answer)How many hours of sleep do you average per night, and how would you rate your sleep quality?
- Current Stress Level (Linear scale)Rate your average daily stress level on a scale from 1 (Very Low) to 5 (Extremely High).
- Meals Per Day (Dropdown)How many meals or substantial snacks do you typically consume each day?
- Daily Water Intake (Short answer)Estimate how many glasses or ounces of water you drink daily.
- Primary Wellness Goals (Paragraph)What are your top 1-2 health or wellness goals for working together?
- Health Areas to Improve (Checkboxes)Select the areas you most want to focus on improving.
- Additional Comments or Questions (Paragraph)Share anything else you would like your coach or practitioner to know.
FAQ
What is a wellness evaluation form used for?
It is used by health coaches, personal trainers, and wellness professionals to gather vital health history, lifestyle habits, nutritional details, and personal goals before starting a new client program.
Can I customize the questions in this template?
Yes! Once you convert the template into Google Forms using Doc2Form, you have full control to add, remove, or edit any questions to fit your specific practice.
How do clients access and fill out this form?
You can share the Google Form link directly via email, embed it on your website, or send it out as part of your welcome packet before a client's first consultation.
Is this wellness evaluation template free to use?
Yes, this template is completely free to convert and deploy into your Google Workspace account.
How does Doc2Form help me set up this form?
Doc2Form instantly transforms this professional template structure directly into your Google Forms account, saving you from manually copying and pasting dozens of fields.
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.