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Health & Wellness template

Free client health intake form template

Onboard a new client without opening on their medical history. Name and contact first, health questions second, goals and consent last — which is the order the research says keeps people in a form rather than losing them at question one.

Questions
11 — 6 required
Format
Multi-step
Theme
Soft, changeable to any of the 22
Cost
Free, with no cap on responses

Before we start

Your name

Email address

Phone number

Date of birth

Any conditions or injuries we should know about?

NoYes

+ 6 more questions

Submit

11 questions · Multi-step · Soft theme

The questions it asks

  • Your name*
  • Email address*
  • Phone number
  • Date of birth
  • Any conditions or injuries we should know about?*
  • Tell us a little about them
  • Taking any medication that affects activity?*
  • Which, roughly?
  • What would you like to get out of this?*
  • How often would you like to meet?
  • I confirm the above is accurate and agree to it being used to plan my sessions. This is an intake form, not a medical record — it is not a substitute for advice from a doctor.*

Every question in the template, in order. An asterisk marks a required one — edit, reorder or remove any of them after you open it.

When to use it

  • Personal training
  • Nutrition coaching
  • Therapy and counselling intake
  • Wellness studios

Or dress it differently

It ships in Soft. Switching theme restyles the whole form — type, spacing, field shape and background together — and takes one click.

  • Soft
  • Classic
  • Signal
  • Matrix
  • Aurora
  • Clinic
  • Sunny
  • Bloom
See all 22 themes

Frequently asked questions

Is this HIPAA compliant?

No. This is an intake form to help plan sessions — it is not a medical record and FormSnapp makes no HIPAA claim. If you handle protected health information, use a system built and certified for it.

Why are the health questions on step two?

Because someone asked about medication on the first screen leaves. Once they have given their name and their goals, they carry on.

Can I change what's asked?

Every question, and the consent wording, is editable.

Designed to be answered

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