About this template
A wellness consultation questionnaire is an essential assessment tool used to evaluate an individual's physical health, mental well-being, nutritional habits, and lifestyle risk factors. Whether you are a health coach, personal trainer, nutritionist, or wellness clinic, conducting a thorough intake before your first session allows you to tailor your programs effectively and provide the professional attention your clients deserve.
This comprehensive Google Form template streamlines your onboarding process by capturing detailed data on sleep patterns, daily activity levels, dietary preferences, stress triggers, and medical history. Instead of spending valuable session time on paperwork, you can review client responses in advance and arrive prepared with personalized recommendations.
Doc2Form makes it simple to deploy and customize this questionnaire for your practice. Share the form via a direct link in your welcome email or embed it directly on your website. All submissions route instantly to Google Sheets, allowing you to organize client data securely and track their readiness for change over time.
Key features
- Collect detailed health, nutrition, and lifestyle data before the first consultation.
- Assess sleep quality, stress levels, and daily energy ratings in one organized view.
- Fully customizable questions to match your specific coaching methodology.
- Optimized for desktop and mobile devices so clients can complete it anywhere.
- Automatically saves all responses to Google Sheets for effortless tracking.
Use cases
New client onboarding for personal trainers and private fitness studios.
Initial health and nutrition assessments by registered dietitians and…
Initial health and nutrition assessments by registered dietitians and health coaches.
Holistic intake for wellness retreats and spa programs.
Lifestyle evaluation prior to starting a therapeutic or counseling pr…
Lifestyle evaluation prior to starting a therapeutic or counseling program.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Gender (Dropdown)Select your gender identity.
- Date of Birth (Date)Enter your birth date.
- Job Activity Level (Multiple choice)Describe your typical daily physical activity level during work hours.
- Diet Style Status (Dropdown)Do you follow a specific dietary pattern?
- Dietary Details & Restrictions (Paragraph)Describe any food allergies, intolerances, or specific dietary rules you follow.
- Daily Water Intake (Short answer)How many glasses or ounces of water do you typically drink per day?
- Weekly Alcohol Consumption (Multiple choice)How often do you consume alcoholic beverages in a typical week?
- Supplement Use (Paragraph)Do you regularly take vitamins, minerals, or other supplements?
- Nightly Sleep Duration (Dropdown)How many hours of sleep do you typically get per night?
- Sleep Quality Rating (Linear scale)Rate your overall sleep quality from 1 (Very Poor) to 5 (Excellent).
- Diagnosed Health Conditions (Paragraph)List any past or current medical diagnoses, chronic illnesses, or major injuries.
- Current Medications (Paragraph)List any prescription medications or regular over-the-counter drugs you take.
- Stress Level (Linear scale)Rate your average daily stress level from 1 (Low) to 10 (Extremely High).
- Other Notable Stressors (Paragraph)Describe any major sources of stress in your personal or professional life.
- Weekly Intense Exercise Frequency (Multiple choice)How many times per week do you engage in vigorous physical exercise?
- Exercise Types & Duration (Paragraph)What types of workouts do you enjoy, and how long do they usually last?
- Current Cigarette Smoker Status (Multiple choice)Do you currently smoke cigarettes or use tobacco products?
- Habits to Cut Out (Paragraph)List any daily habits or behaviors you are hoping to break or reduce.
- Lifestyle Changes to Add (Paragraph)What positive habits or routines are you hoping to introduce into your daily life?
- Readiness for Change Rating (Linear scale)How ready do you feel to make meaningful lifestyle changes right now? (1 = Not ready, 5 = Completely ready)
FAQ
Why should I use a wellness questionnaire template?
A wellness questionnaire helps you gather vital insights into a client's physical, mental, and emotional health before your session. It saves time during consultations and allows you to build safer, more targeted programs.
What kind of information does this questionnaire collect?
It covers a wide range of wellness indicators, including daily activity levels, dietary habits, sleep duration and quality, stress and anxiety levels, hydration, and relevant medical history.
When should clients fill out this form?
Clients should complete the form online a few days before their scheduled initial consultation. This gives you adequate time to analyze their responses and prepare customized recommendations.
Can I customize the questions on this template?
Yes. Once you open the template in Google Forms, you can easily add, remove, or edit any questions to align with your specific practice or program requirements.
How do I share this form with my clients?
You can share the form by copying the Google Form link into your welcome emails, messaging apps, or by embedding it directly onto your website.
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.