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Health Coaching Intake Form - Free Healthcare Template | ZenBuild | ZenBuild

Templates→Healthcare→Health Coaching Intake Form

Health Coaching Intake Form

Gathers lifestyle, habits, and wellness goals for new health coaching clients.

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Template Details

CategoryHealthcare

IndustryHealthcare

Fields8

Uses0

Views13

healthcarehealth coachingwellnesslifestyleintake

Health Coaching Intake Form — Form Fields

This healthcare template includes 8 fields. Gathers lifestyle, habits, and wellness goals for new health coaching clients. Free to customize and use on ZenBuild.

Full Name (text, required)
Email Address (email, required)
What are your main health and wellness goals? (long text, required)
Areas you want to focus on (checkboxes, optional) — options: Nutrition / diet, Exercise / movement, Sleep quality, Stress management, Weight management, Mental well-being
How would you rate your current overall health? (rating, required)
How committed are you to making lifestyle changes? (dropdown selection, required) — options: Very committed, Somewhat committed, Exploring options
What obstacles have prevented you from reaching your health goals? (long text, optional)
Any medical conditions your coach should be aware of? (long text, optional)