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Wellness Consultation Questionnaire Form Template

Assess your clients' health effectively with this comprehensive template

Struggling to gain a clear picture of your clients' health? This wellness consultation questionnaire template is designed for health practitioners like you, aiming to assess clients' physical and mental well-being. With this form, you can identify risk factors, understand lifestyle habits, and evaluate wellness needs, all while ensuring your process is streamlined and user-friendly. Easily customizable to fit your practice, it's an efficient way to gather essential information and enhance client care. Explore the template to start gathering insights today.

Full name
Email address
Phone number
Preferred contact method
Email
Phone call
Text/SMS
Any method
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Gender (optional)
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
If yes or relevant, please share details (diagnoses, medications/supplements, allergies).
Are there any health conditions, medications, or allergies we should consider?
Yes
No
What are your top wellness goals?
How would you rate your current sleep quality?
Poor
Below average
Average
Good
Exceptional
How often do you exercise in a typical week?
Very rarely
Rarely
Sometimes
Often
Very often
How often do you experience stress that affects your day?
Very rarely
Rarely
Sometimes
Often
Very often
Which topics would you like to prioritize during the consultation?
Preferred consultation format
Video call
Phone call
In person (if available)
No preference
How likely are you to seek ongoing wellness support after the free consultation?
0 Not at all likely
1
2
3
4
5 Extremely likely
Preferred consultation date
Best time windows for your appointment
Early morning (6-9am)
Morning (9am-12pm)
Afternoon (12-3pm)
Late afternoon (3-6pm)
Evening (6-8pm)
No preference
May we send reminders and resources related to your consultation?
Yes
No
Type your full name as an electronic signature
Date of signature
I understand this consultation is educational and not a substitute for medical care.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration depicting a wellness consultation questionnaire form design for FormCreatorAI article

When to use this form

Use this form before a first session, during program onboarding, or when renewing a plan. It helps trainers, health coaches, nutritionists, and clinic staff gather history, habits, goals, and risks in one pass. With clear intake data, you can personalize recommendations, screen red flags, and set baselines to measure change. Pair it with the Weekly check-in form to track progress and adjust coaching. If you specialize in fat loss, add the Weight loss questionnaire form for deeper nutrition and behavior insights. Offering fitness services too? Combine this with the Personal training client intake form to streamline scheduling, waivers, and readiness in one workflow.

Must Ask Wellness Consultation Questionnaire Questions

  1. What are your top three wellness goals for the next 90 days?

    Specific, time-bound goals clarify priorities and help you set realistic milestones. You can tailor your plan and measure wins that keep motivation high.

  2. Do you have any diagnosed conditions, current medications, or allergies we should know about?

    Safety comes first: this informs contraindications, referral needs, and intensity limits. It also prevents plan conflicts with prescriptions or sensitivities.

  3. How would you describe your current activity level, sleep quality, and daily stress?

    This establishes a baseline for energy, recovery, and capacity so you pace change appropriately. For fitness-focused clients, a Personal training evaluation form can add movement screens and strength benchmarks.

  4. What does a typical weekday and weekend look like for your meals, snacks, hydration, and alcohol?

    Real patterns reveal gaps, triggers, and easy wins without guesswork. You can propose small, specific changes that fit the clients routine.

  5. How do you prefer to be supported and held accountable (check-ins, reminders, coaching style)?

    Knowing the support style your client responds to improves follow-through and satisfaction. It guides your cadence, channel, and tone so adherence feels doable.

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