About this template
Understanding a client's daily habits, nutrition, sleep cycles, and exercise routines is essential for effective health coaching and wellness planning. This Wellness Survey template provides a comprehensive framework to collect detailed lifestyle data from clients or patients before starting a new program. It covers everything from daily water intake and meal schedules to sleep duration, energy levels, and specific health goals.
Designed for health coaches, nutritionists, wellness clinics, and personal trainers, this form streamlines client intake and health assessments. Instead of managing scattered notes or confusing paper questionnaires, wellness professionals can instantly generate a ready-to-use Google Form using Doc2Form. The structured format ensures you capture all necessary data points while providing respondents with a clean, easy-to-navigate experience.
Use the collected insights to tailor your coaching programs, track client progress over time, and establish a clear baseline for health improvements. Customizing questions or adding specific dietary preferences to match your practice takes only seconds.
Key features
- Comprehensive tracking for daily nutrition, hydration, and meal schedules.
- Built-in sections for sleep quality, energy levels, and stress indicators.
- Detailed fields for physical activity and fitness routines.
- Easy customization to fit specific health coaching programs or clinic workflows.
- Instant deployment as a ready-to-use Google Form.
Use cases
- Initial client intake for nutritionists and dietitians.
- Health assessments for personal trainers and fitness coaches.
- Lifestyle data collection for corporate wellness programs.
- Holistic health intake for wellness clinics and practitioners.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Email Address (Short answer)Where can we reach you with your assessment results or follow-up notes?
- Phone Number (Short answer)Enter your preferred contact number.
- Dietary Preference (Dropdown)Select the option that best describes your typical diet.
- Daily Water Intake (Glasses) (Multiple choice)Estimate how many 8oz glasses of water you drink on an average day.
- Daily Coffee and Tea Count (Short answer)How many cups of caffeinated beverages do you consume daily?
- Weekly Takeaway Frequency (Multiple choice)How often do you order takeout or eat restaurant meals per week?
- Weekly Standard Alcoholic Drinks (Dropdown)Estimate your average weekly alcohol consumption.
- Nightly Sleep Hours (Multiple choice)How many hours of sleep do you typically get per night?
- Daily Energy Level (Linear scale)Rate your average daily energy level on a scale from 1 (Very Low) to 5 (High Energy).
- Peak Hunger and Tiredness Times (Paragraph)At what times of day do you experience peak hunger or afternoon fatigue?
- Exercise Status (Multiple choice)Which best describes your current physical activity routine?
- Weekly Exercise Types (Checkboxes)Select the types of physical activity you regularly enjoy.
- Current Supplements Taken (Paragraph)List any vitamins, minerals, herbal products, or sports supplements you currently take.
- Health Concerns and Goals (Paragraph)Share your primary health goals and any specific concerns you would like to address in our program.
FAQ
How do I use this wellness survey template?
With Doc2Form, you can instantly turn this template into a live Google Form. Simply review the questions, customize them to fit your practice, and share the link with your clients.
Can I add or remove questions from the survey?
Yes! Once the form is generated in your Google Drive, you have full control to add new questions, edit existing options, or remove fields that do not apply to your practice.
What kind of data does this survey collect?
The survey captures a wide range of lifestyle and health metrics, including daily meal habits, hydration levels, caffeine and alcohol intake, sleep hours, exercise routines, and primary health goals.
Who is this wellness survey designed for?
It is ideal for health coaches, nutritionists, personal trainers, wellness consultants, and holistic practitioners looking to understand their clients' daily habits.
Where are the survey responses stored?
All responses are automatically saved in a Google Sheet linked directly to your Google Form, making it easy to review, organize, and analyze client data.
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.