About this template
Understanding daily health habits and lifestyle patterns is essential for effective coaching, health assessments, and personal development. This Wellness Quiz template provides a structured way to evaluate key pillars of well-being, including sleep quality, physical activity, nutrition, mindfulness, and stress management.
Designed for healthcare professionals, wellness coaches, fitness centers, and counselors, this form helps gather comprehensive baseline data from clients or participants. Instead of building a health audit from scratch, you can instantly deploy this template via Doc2Form to collect clear, actionable insights into an individual's physical and mental health habits.
Respondents are guided through a series of thoughtful questions regarding their daily routines, coping mechanisms, and support networks. The resulting data enables practitioners to identify areas for improvement, track progress over time, and tailor recommendations to support healthier lifestyle outcomes.
Key features
- Evaluate key health pillars including sleep, nutrition, and stress.
- Quickly deploy via Google Forms without manual questionnaire design.
- Gather structured lifestyle data for coaching or health programs.
- Easily customize questions to fit specific clinical or wellness frameworks.
Use cases
Initial health intake assessments for new wellness coaching clients.
Employee wellness program baseline surveys and health awareness campa…
Employee wellness program baseline surveys and health awareness campaigns.
Fitness center onboarding questionnaires to gauge member habits.
Self-assessment tools for individuals tracking personal health goals.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Email Address (Short answer)Where should we send your wellness summary and recommendations?
- Average Sleep Hours (Night) (Dropdown)How many hours of sleep do you typically get per night?
- Physical Activity Frequency (Multiple choice)How often do you engage in moderate to vigorous physical exercise?
- Balanced Diet Status (Multiple choice)How would you describe your daily nutritional habits and intake of whole foods?
- Mindfulness / Relaxation Frequency (Multiple choice)How often do you practice meditation, deep breathing, or intentional relaxation?
- Emotional Support System Status (Multiple choice)Do you feel you have reliable friends, family, or colleagues to turn to during difficult times?
- Mind-Challenging Activity Frequency (Multiple choice)How often do you engage in activities that challenge your mind (e.g., reading, puzzles, learning a new skill)?
- Stress & Anxiety Coping Status (Linear scale)How effectively do you feel you manage daily stress and anxiety?
- Social Connection Frequency (Multiple choice)How often do you connect meaningfully with friends, family, or community members?
- Community Belonging Status (Multiple choice)Do you feel a sense of belonging in your local community, workplace, or social groups?
- What is your primary wellness goal for the next 3 months? (Paragraph)Share what you most want to improve regarding your health or well-being.
FAQ
How can I share this wellness quiz with clients or participants?
Once you convert and open your form in Google Forms, you can share it via a direct link, email invitation, or embed it directly on your website.
Can I modify the questions to match my specific coaching methodology?
Yes, completely. Google Forms allows you to add, edit, or remove any questions, change response types, and reorder sections to fit your exact needs.
Is this form template free to use?
Yes! Doc2Form lets you instantly generate this form in Google Forms at no cost.
How do I review the responses submitted by participants?
All submissions are automatically collected in a linked Google Sheet, allowing you to easily review individual results or analyze trends across multiple participants.
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.