Wellness Coaching Intake

Holistic intake form for wellness coaching covering physical health, mental wellbeing, and lifestyle factors.

Template Content

WELLNESS COACHING INTAKE FORM PERSONAL INFORMATION ================== Name: _________________________ Age: _________________________ Email: _______________________ Phone: ______________________ Emergency Contact: ____________ Preferred Communication: ☐ Email ☐ Phone ☐ Text CURRENT HEALTH STATUS ==================== 1. Please describe your current overall health: ☐ Excellent ☐ Very good ☐ Good ☐ Fair ☐ Poor 2. Do you have any current health conditions or concerns? ☐ Yes ☐ No If yes, please describe: _________________ 3. Are you currently taking any medications or supplements? ☐ Yes ☐ No If yes, please list: ____________________ [Form continues with physical wellness, mental/emotional wellness, lifestyle habits, wellness goals, motivation assessment, support systems, and coaching preferences]

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