HelloForms
Wellness · free template

Health Screening Questionnaire

Quick pre-activity or pre-visit wellness check to flag anything that needs a closer look.

A ready-to-use fitness, wellness & coaching form for clinics, coaches and therapists: 8 questions, 1 page, 2 conditional rules.

Questions
8
Pages
1
Layouts
classic · card
Conditional rules
2
Typical time
3 min
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Live preview and test console

This is the real form. Answer it to test the flow — nothing is sent or stored.

Health screening questionnaire

This response will be flagged for staff review before you proceed.

This template runs as a straight sequence — no branching rules.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

Health Screening Questionnaire is built for clinics, coaches and therapists who need to collect intake detail and consent before the first session.

  • Clinics, coaches and therapists working in fitness, wellness & coaching.
  • Teams who need to collect intake detail and consent before the first session without writing code or paying for a custom build.
  • Anyone replacing paperwork eating the start of every appointment with one structured record per enquiry.
  • Respondents are clients and patients — the form asks them 8 questions across 1 screen.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of paperwork eating the start of every appointment and turns each submission into a record your team can act on immediately.

  • 5 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It pins the request to a specific date.
  • Conditional logic hides 2 questions until they are relevant — shorter forms convert better than long ones.
  • Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Health Screening Questionnaire lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 2 conditional rules ship with it.

  • Features advanced show logic: if “Any 'yes' answer on this form” is Yes, the form dynamically exposes “Please briefly describe”. Otherwise that question never appears.
  • Features advanced show logic: if “Any 'yes' answer on this form” is Yes, the form dynamically exposes “This response will be flagged for staff review before you proceed.”. Otherwise that question never appears.
  • All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

Before a fitness class, physical activity or in-person visit, a quick health check can catch something worth flagging without turning into a full medical history. This form asks a short set of yes/no questions covering the most common red flags — chest pain or discomfort, dizziness or fainting, current illness or fever, and any recent injury or surgery. Answering 'yes' to any of them immediately reveals a matching follow-up field asking for a brief description, so the person running the screening gets just enough detail to decide whether to proceed, adjust the activity, or suggest the person check with a doctor first — without asking everyone the same long list of detail questions regardless of relevance. A general notes field at the end catches anything not covered by the specific questions, like a temporary mobility limitation or a known allergy relevant to the activity. Every submission with any 'yes' answer is meant to be flagged for a quick human review before the person proceeds, whether that's a staff member having a two-minute conversation or a clinician glancing at the notes before an appointment starts. This is a screening tool, not a diagnosis, and it doesn't replace a proper medical assessment when one is genuinely needed.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Quick health check

  • Full namerequired
  • Date
  • Have you experienced chest pain or discomfort in the last 7 days?required
  • Have you felt dizzy or fainted recently?required
  • Do you currently have a fever, cough or other signs of illness?required
  • Have you had a recent injury or surgery?required
  • Please briefly describe
  • Anything else we should know?

8 questions in total.

How the form changes as it's filled in

This template ships with 2 conditional rules, grouped into 1 behaviour driven by 1 question. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Any 'yes' answer on this form”

  • Reveals questions

    If “Any 'yes' answer on this form” is Yes, the form reveals “Please briefly describe” and “This response will be flagged for staff review before you proceed.”.

Set it up step by step

  1. 1

    Review flagged answers before the activity starts

    Have a staff member glance at any 'yes' answer and have a brief conversation before the person proceeds.

  2. 2

    Keep it short on purpose

    Resist adding more questions — the value of this form is speed; anything needing more detail should go to a proper intake form instead.

  3. 3

    Set a clear escalation rule

    Decide in advance what a 'yes' on chest pain or fainting means for your setting — pause the activity, suggest a doctor's note, or reschedule.

  4. 4

    Use it every visit, not just the first

    Health status changes day to day, so a fresh screening each session catches more than a one-time intake form.

Mistakes to avoid

  • Treating a 'yes' answer as automatic disqualification instead of a prompt for a quick conversation.
  • Adding too many detail questions and turning a 3-minute check into a full medical history.
  • Not reviewing flagged responses before the person starts the activity, defeating the point of the screening.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Have staff review any 'yes' answers before the person proceeds, keep a record of flagged responses, and suggest a medical check where the described symptom seems significant.

Works in both layouts

Browse classic templatesBrowse card templates

Forms that overlap this one

These pages cover the same subject ground as the health screening questionnaire, matched on the words people actually search for.

Privacy & compliance

This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.

Frequently asked questions

Is this a medical diagnosis tool?

No — it's a quick flag-and-review screening step, not a diagnosis or substitute for a doctor's assessment.

Can I use this before every gym class?

Yes, that's a common use — many studios run this at check-in for new or infrequent attendees, or seasonally for regulars.

What should staff do with a flagged response?

Have a brief conversation with the person, note the outcome, and decide together whether to proceed, modify the activity, or suggest they see a doctor first.

Should I keep completed forms on file?

Yes, keep a record of flagged responses in case you need to refer back to them, following your organization's data retention practices.

Is the Health Screening Questionnaire template free to use?

Yes. You can preview and test Health Screening Questionnaire on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Health Screening Questionnaire template ask for?

It asks 8 questions across 1 page, 5 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Health Screening Questionnaire form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this fitness, wellness & coaching form work?

2 conditional rules ship with the template: Features advanced show logic: if “Any 'yes' answer on this form” is Yes, the form dynamically exposes “Please briefly describe”. Otherwise that question never appears. Features advanced show logic: if “Any 'yes' answer on this form” is Yes, the form dynamically exposes “This response will be flagged for staff review before you proceed.”. Otherwise that question never appears. All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other. All rules are editable in the Logic tab.

Where do responses to the Health Screening Questionnaire form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Health Screening Questionnaire form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

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Related categories

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