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Health Coaching Intake Form Template

Every effective health coaching relationship begins with a clear picture of where the client is today. This intake form collects health history, current habits, primary goals, and prior attempts — giving you everything you need to design a personalized health plan before your first session.

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The starting point

About this template

A health coaching intake form does more than collect information — it starts the coaching process. By asking clients to articulate their health history, current habits, and the specific challenges they've already faced, the form itself prompts self-reflection that sets the tone for accountability and change.

More about this template

This template is built for the realities of health coaching practice. The health challenges checkbox captures comorbidities that affect program design. The 'what have you tried' field is invaluable — clients who've done keto, tried every supplement, and worked with personal trainers need a different approach than someone just starting out. And the doctor clearance question protects both coach and client from a professional liability standpoint.

formformform handles these sensitive intake forms securely and delivers submissions instantly. Coaches can review the full intake before the first session and arrive with a program framework already in mind, which clients experience as expertise and preparation — a strong start to any coaching relationship.

11 fields to make your own7 required in this starting form

Make it fit your workflow.

Use your own copy to change labels, remove questions and add the details you need. Try the preview alongside this guide to see what respondents will be asked.

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The questions, explained

Fields in this template

Review the starting questions and choices. You can change them in your own copy.

  • Short answerRequired

    Full Name

    Maria Garcia

  • Email addressRequired

    Email Address

    maria@example.com

  • Phone numberOptional

    Phone Number

    (555) 234-5678

  • DateRequired

    Date of Birth

  • DropdownRequired

    Primary Health Goal

    11 choices
    • Weight loss / body composition
    • Energy and vitality
    • Stress reduction
    • Better sleep
    • Improved nutrition and eating habits
    • Fitness and physical performance
    • Chronic condition management
    • Hormonal health and balance
    • Gut health and digestion
    • Mental wellness and mood
    • Other
  • NumberOptional

    Current Weight (lbs) — Optional

    150

  • Long answerRequired

    Health History and Current Habits

    Describe your current health status, any diagnoses or conditions, medications, and your typical daily habits around food, movement, sleep, and stress.

  • Multiple choiceOptional

    Current Health Challenges (Select All That Apply)

    12 choices
    • Chronic fatigue
    • Digestive issues
    • Anxiety or depression
    • High blood pressure
    • Diabetes or pre-diabetes
    • Thyroid issues
    • Autoimmune condition
    • Joint pain or chronic pain
    • Sleep disorders
    • Food sensitivities or allergies
    • Hormonal imbalances
    • None of the above
  • Long answerOptional

    What Have You Tried Before and What Were the Results?

    List any diets, programs, treatments, or approaches you've tried in the past and what happened — including what worked for a time and what didn't.

  • Single choiceRequired

    Have You Received Clearance From Your Doctor to Begin a Health Program?

    4 choices
    • Yes, I have doctor's clearance
    • Not yet, but I plan to get it
    • My doctor is aware of my goals
    • I don't plan to consult a doctor for this
  • DropdownRequired

    Commitment Level to Your Health Journey

    4 choices
    • Fully committed — ready to make real changes
    • Mostly committed — some areas feel challenging
    • Getting started — still figuring out my readiness
    • Early stages — just exploring what's possible
Where it fits

Who uses this template

Suggested uses, and why this starting point can help. Adapt the questions to your own process.

Health coaches

Collects menstrual cycle details, perimenopause symptoms, energy patterns, and lab history for coaches specializing in hormonal balance.

Wellness coaches

Captures symptom severity, hormone therapy status, and lifestyle goals for coaches specializing in guiding women through menopause transitions.

Nutrition coaches

Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Current Weight (lbs) — Optional” in particular and adapt it to the detail you need.

Functional medicine health coaches

Collects menstrual cycle details, perimenopause symptoms, energy patterns, and lab history for coaches specializing in hormonal balance.

Holistic health practitioners

Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Current Health Challenges (Select All That Apply)” in particular and adapt it to the detail you need.

Weight loss coaches

Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “What Have You Tried Before and What Were the Results?” in particular and adapt it to the detail you need.

Corporate wellness coaches

Captures workplace stress factors, sedentary patterns, and worksite wellness goals for employees participating in employer-sponsored programs.

Integrative health coaches

Collects menstrual cycle details, perimenopause symptoms, energy patterns, and lab history for coaches specializing in hormonal balance.

What's included

Primary health goal dropdown covering weight, energy, sleep, stress, and chronic conditions
Optional current weight field with appropriate number validation
Comprehensive health history and daily habits textarea
Multi-select checkbox for current health challenges
Previous program results field to avoid repeating past failures
Doctor clearance radio button for liability and safety
Commitment level assessment for realistic expectation-setting
Date of birth for age-appropriate program design

How to create a health coaching intake form

  1. 1

    Click 'Use this template' to open this health coaching intake form in formformform.

  2. 2

    Customize the primary health goal dropdown to match your coaching specialty — remove goals outside your scope of practice.

  3. 3

    Add any specialty-specific questions, such as a food diary field for nutrition coaches or movement history for fitness-focused health coaches.

  4. 4

    Consider adding a waiver or disclaimer paragraph if your practice requires one.

  5. 5

    Set your notification email to receive each intake form the moment a client submits it.

  6. 6

    Share the form link via your booking confirmation email or practice management platform.

Best practices for your health coaching intake form

Always ask about doctor clearance

it's both a professional responsibility and a signal to clients that their safety is your priority. Document their response.

Ask about past attempts before recommending anything

clients who have tried and failed the same approach multiple times need a fundamentally different strategy, not the same advice worded differently.

Use the health challenges checkbox rather than a free-text field

structured options are easier to complete and ensure you don't miss critical conditions.

Don't require the weight field

some clients are sensitive about disclosing numbers before trust is established. Making it optional gets you more completions.

Follow up on concerning answers

if a client checks 'autoimmune condition' and 'chronic fatigue' and hasn't seen a doctor in years, your first session agenda just wrote itself.

Store intake forms in client files

reference them at program checkpoints to demonstrate progress and show clients how far they've come.

12 form ideas you can build with this template

Weight Loss Coaching Intake Form

Captures body composition goals, eating patterns, dieting history, and emotional relationship with food for weight loss program design.

Hormone Health Coaching Intake

Collects menstrual cycle details, perimenopause symptoms, energy patterns, and lab history for coaches specializing in hormonal balance.

Gut Health Coaching Intake

Gathers digestive symptoms, food sensitivities, antibiotic history, and elimination patterns for functional gut health coaching programs.

Corporate Wellness Coaching Intake

Captures workplace stress factors, sedentary patterns, and worksite wellness goals for employees participating in employer-sponsored programs.

Chronic Disease Lifestyle Coaching Intake

Documents diagnosis, medication, and lifestyle factors for coaches helping clients with diabetes, hypertension, or autoimmune conditions manage symptoms through behavior change.

Postpartum Health Coaching Intake

Gathers recovery status, breastfeeding context, sleep deprivation level, and new-parent health goals for postnatal wellness coaching.

Menopause Wellness Coaching Intake

Captures symptom severity, hormone therapy status, and lifestyle goals for coaches specializing in guiding women through menopause transitions.

Athletic Performance Nutrition Coaching Intake

Collects sport type, training volume, race or competition schedule, and fueling challenges for endurance athletes and competitive sports nutrition coaching.

Anti-Inflammatory Lifestyle Coaching Intake

Gathers inflammatory markers, dietary patterns, and symptom triggers for coaches helping clients reduce systemic inflammation through food and lifestyle.

Pediatric Health Coaching Intake (Parent Form)

Collects child health history, dietary habits, activity level, and parent goals for coaches working with families to improve children's health.

Mental Wellness and Stress Coaching Intake

Captures stress triggers, coping mechanisms, sleep quality, and mood patterns for health coaches addressing burnout and mental wellness.

Senior Wellness Coaching Intake

Gathers mobility limitations, medication interactions, social engagement levels, and independence goals for older adult health coaching programs.

Frequently asked questions

What should a health coaching intake form ask about?

At minimum: primary health goal, basic health history, current habits (diet, movement, sleep, stress), any diagnoses or conditions, what approaches have already been tried, and doctor clearance status. Age and commitment level help with program personalization.

Do health coaches need a doctor clearance question on their intake form?

Best practice is yes. Health coaches operate within a scope of practice that excludes medical diagnosis and treatment. Documenting that a client has physician awareness or clearance protects the coach professionally and ensures clients aren't substituting coaching for necessary medical care.

How is health coaching different from personal training?

Health coaching addresses the full lifestyle picture — nutrition, sleep, stress, habits, mindset, and movement — rather than training sessions alone. The intake form reflects this breadth, asking about all lifestyle domains rather than just fitness history.

Can I use this form for virtual health coaching clients?

Yes — the form works identically for in-person and virtual clients. The share link can be sent via email, embedded in a scheduling confirmation, or placed on your website.

Should the health coaching intake form be HIPAA compliant?

Health coaches are typically not HIPAA-covered entities unless they work within a healthcare system. However, if you receive protected health information, consult a compliance advisor. For standard health coaching practices, formformform's data handling is appropriate.

How often should I ask clients to update their health intake?

A refresh every 3–6 months is common in ongoing coaching relationships. You can reuse this template or send a shorter 'progress check-in' form to capture changes since the original intake.

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