Wellness · free template

Wellness Questionnaire Form

Collect wellness goals, current habits, medications and medical context so a coach can tailor a plan without duplicating a full clinical intake form.

A ready-to-use fitness, wellness & coaching form for clinics, coaches and therapists: 14 questions, 1 page, 3 conditional rules.

Questions: 14
Pages: 1
Layouts: classic · card
Time to complete: ≈ 7 min
Conditional rules: 3

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Compliance checklist

Ready to publish

Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
Medical disclaimer present — passingThis form does not provide medical advice, diagnosis or treatment. Information you share here is not a substitute for care from a qualified clinician. In an emergency, contact your local emergency service immediately.
Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.

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

Wellness Questionnaire 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 14 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.

8 questions are required, so submissions arrive complete instead of needing a follow-up email.
It collects a verified email address so replies and confirmations land.
It measures sentiment on a numeric scale.
It allows multiple selections without free text.
It captures a numeric value you can filter and sort on.
Conditional logic hides 3 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.

1Press “Use this template” — a fresh copy of Wellness Questionnaire 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 “Do you have any current medical conditions?” is Yes, “Describe your medical conditions” becomes mandatory before the form can be sent.
Features conditional validation: if “Are you currently taking any medications?” is Yes, “List your medications” becomes mandatory before the form can be sent.
Features conditional validation: if “Do you currently exercise regularly?” is No, “Anything else you'd like us to know?” becomes mandatory before the form can be sent.
All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

A wellness questionnaire sits in an awkward middle ground: it needs enough medical context to plan safely, without becoming the full clinical intake a doctor's office would run. This form asks for the primary goal first — weight management, stress reduction, sleep, energy, nutrition, or general wellbeing — then which specific areas the client wants support with, since goals and support areas don't always line up the way you'd expect. Medical conditions and medications are asked as simple yes-or-no questions with a conditional detail field, so nothing is skipped but nothing is over-collected either; a client with nothing relevant to disclose isn't stuck staring at an empty required field. Current activity level and a stress rating on a simple scale round out the picture a coach actually needs to build a starting plan. What this form deliberately avoids is anything that reads as a diagnosis or a clinical screening tool — it exists to inform coaching, not to replace a conversation with a physician, and it says so plainly in its closing agreement. Coaches working with clients who disclose significant medical conditions should always recommend clearance from a healthcare provider before starting a new program, regardless of what's collected here.

What this form asks

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

Wellness questionnaire

Full namerequired
Email addressrequired
Height (inches or cm)
Current weight
Primary wellness goalrequired
Areas you'd like support withrequired
Do you have any current medical conditions?required
Describe your medical conditions
Are you currently taking any medications?required
List your medications
Do you currently exercise regularly?required
How would you rate your current stress level?
Anything else you'd like us to know?
Agreementrequired

14 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 3 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Do you have any current medical conditions?”

Makes answers required
If “Do you have any current medical conditions?” is Yes, “Describe your medical conditions” becomes required before the form can be submitted.

Driven by “Are you currently taking any medications?”

Makes answers required
If “Are you currently taking any medications?” is Yes, “List your medications” becomes required before the form can be submitted.

Driven by “Do you currently exercise regularly?”

Makes answers required
If “Do you currently exercise regularly?” is No, “Anything else you'd like us to know?” becomes required before the form can be submitted.

Set it up step by step

1
Keep medical questions yes/no with a follow-up
This avoids over-collecting from clients with nothing relevant to disclose while still catching real detail when it exists.
2
Separate the goal from the support areas
A client's stated goal and where they actually want help don't always match — ask both rather than assuming.
3
Use a simple scale for stress
A 0-10 rating is quick to complete and gives you a baseline to compare against later without turning the form into a clinical assessment.
4
Say plainly what this form is not
A short disclaimer that this isn't medical advice protects both the client and the coach, and should sit next to the final agreement.

Mistakes to avoid

Collecting detailed medical history without a clear purpose, which risks turning a wellness form into an unlicensed clinical intake.
Assuming a stated goal automatically maps to the support area a client actually wants help with.
Starting a new exercise plan with a client who has disclosed a medical condition without recommending physician clearance first.

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

Review medical disclosures before finalising a plan, recommend physician clearance where relevant, and build the first session around the stated goal and support areas.

Works in both layouts

Browse classic templates Browse card templates

Forms that overlap this one

These pages cover the same subject ground as the wellness questionnaire 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

Is this a substitute for a medical intake form?

No. It gives a coach enough context to plan safely, but it isn't a clinical screening tool. Clients with significant medical conditions should get clearance from a healthcare provider before starting a program.

How is this different from a Coaching Intake Form?

A Coaching Intake Form often focuses on scheduling, preferences and coaching style. This questionnaire goes deeper into health context and habits so a wellness or nutrition plan can be built responsibly.

Should I use this instead of a Health Screening Questionnaire?

Use both if you're planning physical activity with any risk factors — the Health Screening Questionnaire is built specifically around exercise-readiness questions this form doesn't cover in the same depth.

What if a client doesn't want to disclose medical conditions?

Respect that, but note it in your own records and be conservative in program design when medical context is unknown — you can always ask again once trust is established.

Is the Wellness Questionnaire Form template free to use?

Yes. You can preview and test Wellness Questionnaire 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 Wellness Questionnaire Form template ask for?

It asks 14 questions across 1 page, 8 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 Wellness Questionnaire 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 “Do you have any current medical conditions?” is Yes, “Describe your medical conditions” becomes mandatory before the form can be sent. Features conditional validation: if “Are you currently taking any medications?” is Yes, “List your medications” becomes mandatory before the form can be sent. Features conditional validation: if “Do you currently exercise regularly?” is No, “Anything else you'd like us to know?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Wellness Questionnaire 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 Wellness Questionnaire 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 wellness questionnaire form.

Related categories

All Fitness, Wellness & Coaching templates

Wellness Questionnaire Form

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