Wellness · free template

Wellbeing Screening Form

A short, anonymous-friendly check-in on mood, stress and sleep that helps route someone to the right support.

A ready-to-use fitness, wellness & coaching form for clinics, coaches and therapists: 9 questions, 2 pages, 3 conditional rules.

Questions: 9
Pages: 2
Layouts: classic · card
Conditional rules: 3
Typical time: 3 min

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Also filed under

Health assessments

Live preview and test console

This is the real form. Answer it to test the 2 conditional rules — nothing is sent or stored.

Page 1 of 2 — Quick check-in

Every question on this page is currently visible.

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

Wellbeing Screening Form 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 9 questions across 2 screens.
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.

2 questions are required, so submissions arrive complete instead of needing a follow-up email.
It measures sentiment on a numeric scale.
Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
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.

1Press “Use this template” — a fresh copy of Wellbeing Screening Form lands in your workspace, ready to edit.
2Rename or delete any question, and change what is required. Nothing here is fixed.
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.
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.
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 — 3 conditional rules ship with it.

Features conditional validation: if “Would you like someone to follow up with you?” is Yes, please reach out, “Best way to reach you” becomes mandatory before the form can be sent.
Features conditional hiding: if “Would you like someone to follow up with you?” is No thanks, just checking in, “Best way to reach you” is removed from the form and is never submitted.
Features conditional hiding: if “Would you prefer to answer anonymously?” is Yes, keep this anonymous, “Name (optional)” is removed from the form and is never submitted.
All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

This is a short, low-pressure check-in — not a diagnostic tool — designed for workplaces, schools or community programs that want to offer people an easy first step toward support without asking them to book an appointment straight away. It opens with an option to answer anonymously, since people are more candid about mood and stress when their name isn't attached, and follows with a handful of scale questions on mood, stress, sleep and how supported someone feels, kept deliberately broad rather than symptom-specific. A single open question lets someone add context in their own words if they want to. The closing section is the most important part: it asks whether the person would like a follow-up conversation and, if so, how to reach them, with a clear note that anyone in urgent distress should contact emergency services or a crisis line rather than wait for a form response. This form does not screen for or diagnose any condition — it is a conversation starter that helps an organiser know who might want to talk and prioritise outreach accordingly, not a clinical instrument.

What this form asks

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

Page 1 — Quick check-in

Would you prefer to answer anonymously?required
Name (optional)
How would you rate your mood lately?
How manageable does your stress feel right now?
How has your sleep been recently?
Do you feel you have people to turn to if needed?

Page 2 — Anything else

Anything you'd like to share? (optional)
Would you like someone to follow up with you?required
Best way to reach you

9 questions in total.

How the form changes as it's filled in

This template ships with 3 conditional rules, grouped into 3 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Would you like someone to follow up with you?”

Makes answers required
If “Would you like someone to follow up with you?” is Yes, please reach out, “Best way to reach you” becomes required before the form can be submitted.
Hides questions
If “Would you like someone to follow up with you?” is No thanks, just checking in, the form hides “Best way to reach you”, so nobody answers questions that don't apply.

Driven by “Would you prefer to answer anonymously?”

Hides questions
If “Would you prefer to answer anonymously?” is Yes, keep this anonymous, the form hides “Name (optional)”, so nobody answers questions that don't apply.

Set it up step by step

1
Lead with the anonymous option
Offering anonymity up front, not as an afterthought, is what gets people to answer honestly.
2
Keep the scale questions broad
This form checks in generally on mood, stress and sleep — it isn't meant to diagnose or screen for a specific condition.
3
Always show the crisis note
Keep the opening paragraph pointing people to emergency services or a crisis line — never let a form be someone's only route to urgent help.
4
Route follow-up requests quickly
Have a named person check submissions daily so anyone who asks for a follow-up doesn't wait long to hear back.

Mistakes to avoid

Presenting this as a clinical or diagnostic screening tool rather than an informal check-in.
Burying the anonymous option or making name required, which discourages honest answers.
Not checking submissions often enough when someone has asked for follow-up.

What it pairs with

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

Therapy Intake Form
Employee Wellbeing Survey
Anonymous Feedback Form

What to do with the responses

Check submissions on a regular schedule, follow up promptly with anyone who requested contact, and keep crisis-line information visible on the form and in any confirmation message.

Works in both layouts

Browse classic templates Browse card templates

Forms that overlap this one

These pages cover the same subject ground as the wellbeing screening form, 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

Does this diagnose a mental health condition?

No — it's an informal check-in with no diagnostic or clinical claims. Anyone needing assessment or treatment should be pointed to a qualified professional, such as through the Therapy Intake Form.

How is this different from the Therapy Intake Form?

This screening is a quick, often anonymous pulse-check used before someone has decided to seek therapy. The Therapy Intake Form is the fuller onboarding paperwork completed once a client has booked a session.

Is this suitable for a workplace setting?

Yes, many HR and wellbeing teams use a short check-in like this alongside the Employee Wellbeing Survey, which covers broader workplace satisfaction rather than personal wellbeing.

What if someone reports being in crisis?

This form should never be the only channel for urgent support — always display crisis-line or emergency-service information prominently, as shown in the opening text.

Is the Wellbeing Screening Form template free to use?

Yes. You can preview and test Wellbeing Screening Form 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 Wellbeing Screening Form template ask for?

It asks 9 questions across 2 pages, 2 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 Wellbeing Screening Form 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?

3 conditional rules ship with the template: Features conditional validation: if “Would you like someone to follow up with you?” is Yes, please reach out, “Best way to reach you” becomes mandatory before the form can be sent. Features conditional hiding: if “Would you like someone to follow up with you?” is No thanks, just checking in, “Best way to reach you” is removed from the form and is never submitted. Features conditional hiding: if “Would you prefer to answer anonymously?” is Yes, keep this anonymous, “Name (optional)” is removed from the form and is never submitted. All rules are editable in the Logic tab.

Where do responses to the Wellbeing Screening Form 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 Wellbeing Screening Form 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.

More forms teams pair with the wellbeing screening form.

Related categories

All Fitness, Wellness & Coaching templates