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Health and Wellness Assessment Form Template

Capture a complete picture of a client's health in 8 minutes — lifestyle, history, goals, and consent in one shareable form.

A structured health and wellness assessment form covering medical history, lifestyle habits, nutrition, stress, sleep, and personal goals. Practitioners send one link, clients fill it in on their phone before the first session, and you walk into the appointment already knowing what to focus on.

#health#wellness#assessment#intake#lifestyle#coaching#patient
No signup required
AI customizable
✓ Free forever plan✓ Embed on any website✓ GDPR compliant✓ No code required

Why use a health and wellness assessment form?

The first 15 minutes of a wellness consult are usually spent asking the same baseline questions. Sleep hours. Water intake. Medications. Stress level on a scale of 1 to 10. By the time you get to what actually matters — the goal the client booked you for — half the session is gone. A health and wellness assessment form moves all of that to before the appointment. The client opens a link on their phone the night before, takes 8 minutes to fill it in, and you arrive at the session with a complete baseline already in your notes. No clipboard. No re-typing handwritten answers into a chart. It also gives you something paper forms never could: a structured record you can compare against six weeks later. Same form, same questions, same scale — so when a client says "I think I'm sleeping better," you have the data to confirm it.

What's included in this template

16 fields — customize any field or add new ones with AI.

Short textFull name✱
DateDate of birth✱
EmailEmail address✱
PhonePhone number
DateAssessment date✱
Long textPrimary health goal✱
Long textCurrent medical conditions
Long textCurrent medications and supplements
NumberAverage hours of sleep per night
Multiple choicePhysical activity level✱
Rating scaleStress level (1-10)✱
CheckboxesDietary preferences or restrictions
DropdownSmoking and alcohol use
File uploadUpload recent lab results (optional)
CheckboxesConsent to share information with care team✱
SignatureSignature✱

Need different fields?

Tell the AI what to change — "add a budget dropdown" or "remove phone number" — and it edits the form instantly. Every field type above can be added, removed, or relabeled through the chat interface.

Key features of this health and wellness assessment form template

Everything you need to launch this form in minutes, share it with your team, and collect submissions reliably.

1

Pre-session intake

Clients complete the assessment on their phone before the appointment, so you start the session with a full picture instead of a blank chart.

2

Structured lifestyle data

Sleep, stress, activity, and nutrition fields use consistent scales so you can compare a client's answers from week one to week six.

3

Lab upload field

Clients can attach recent bloodwork or imaging as PDFs or photos directly inside the form — no separate email thread needed.

4

Signature + consent

Built-in e-signature and consent checkbox cover information-sharing acknowledgements for HIPAA-conscious workflows.

5

Mobile-first design

Forms render cleanly on any phone screen. Rating scales, dropdowns, and date pickers use native mobile controls.

6

Auto-routing of responses

New submissions land in Google Sheets and ping your Slack channel within 1–2 seconds of the client hitting submit.

Perfect for

Health coaches, functional medicine practitioners, nutritionists, naturopaths, personal trainers, wellness clinics, corporate wellness program managers, and chiropractors who want a clean baseline before the first session and a repeatable way to track progress over time.

How to use this template

1

Open the template

Click "Use this template free." Flexform loads the form instantly — no account needed to preview.

2

Customize with AI

Type what you want to change in the chat: fields to add or remove, rename labels, change field types, or rearrange pages.

3

Connect & publish

Link to Google Sheets or Slack with one click, then embed on your site or share the link.

Ways to use this template

New client intake at a wellness clinic

Send the form link in the booking confirmation email. By the time the client walks in, their lifestyle baseline, goals, and consent are already in your system.

Health coach 1-on-1 onboarding

Independent coaches use the assessment as a structured first conversation. The textarea fields surface the real "why" behind a goal in a way a 30-minute call rarely captures.

Quarterly progress check-ins

Re-send the same form every 12 weeks. Comparing answers side by side makes progress on sleep, stress, and activity tangible — instead of relying on memory.

Corporate wellness program enrollment

HR teams use the form to enroll employees into a wellness program. Data flows to a private Google Sheet that only the program manager and external coach can access.

Functional medicine workups

Practitioners attach the lab-upload field as a way for patients to share recent bloodwork before a deep-dive consult, so the session focuses on interpretation rather than data collection.

Telehealth nutrition consults

Remote nutritionists collect dietary preferences, restrictions, and current medications before a video call so the 45-minute slot is spent on the plan, not the paperwork.

Workflow integrations

Connect this form to your existing tools with no middleware. Every submission triggers your workflow automatically.

Google SheetsSlackEmailWebhook
⚡

Real-time sync

Data appears in your CRM or spreadsheet within 1–2 seconds of submission — no cron jobs, no delays.

🔀

Conditional routing

Route submissions to different Slack channels, HubSpot pipelines, or Airtable bases based on field values.

🔁

Two-way data flow

Pre-fill form fields with CRM data for returning visitors. Update existing records instead of creating duplicates.

Why choose Flexform?

Most wellness forms are either too generic to be useful or too clinical to feel approachable. FlexForm sits in the middle. The template ships with a sensible structure for lifestyle, history, and goals — and if anything doesn't fit your practice, you describe what you want changed in plain English and the AI rewrites the form for you. Add a section on supplement protocols. Remove the alcohol question. Translate the whole thing into Spanish. It takes seconds. Once the form is live, responses flow straight into the tools your practice already uses. New submissions land in Google Sheets as a row you can pivot or filter, and Slack pings whoever owns intake so nothing waits in an inbox overnight. For clinics building their own client app, FlexForm ships a Kotlin Multiplatform mobile SDK that lets you embed the same form natively in Android and iOS — same logic, same validation, same theme. Share a link by SMS or email and clients can fill it in without creating an account or installing anything. The free forever plan covers a small practice end-to-end, and only scales up when you do.
One link, share anywhere
Native iOS & Android SDK
Free forever plan

Frequently asked questions

Is this form HIPAA compliant?

The template gives you the structure and consent fields you'd expect on a HIPAA-conscious intake, but compliance depends on how you handle the data after submission. If your practice operates under HIPAA, talk to us about the business associate agreement and configure your destination integrations accordingly.

Can clients fill this out on a phone?

Yes — every field uses mobile-native controls. Date pickers pop up the native iOS or Android picker, ratings use a touch-friendly scale, and the file upload accepts photos directly from the camera roll.

How do I change the questions to fit my practice?

Open the template in FleurForm and describe the change in plain English — "add a section about supplement protocols" or "remove the alcohol question." The AI rewrites the form in seconds. You can also drag fields around manually if you prefer.

Where do responses go?

Responses are stored inside FlexForm and can be sent in real time to Google Sheets, a Slack channel, an email address, or any webhook endpoint. Most clinics use Sheets for the record and Slack for the live ping.

Can I embed this in my own app?

Yes. FlexForm ships a Kotlin Multiplatform SDK for Android and iOS, so the same form logic and validation runs natively inside your patient or member app. Theme and branding follow your app, not ours.

What happens to the lab uploads?

Uploaded files are attached to the submission record. You can download them individually or route them to a Google Drive folder via webhook. They are never exposed in a public URL.

Do clients need an account to fill it in?

No. They open the share link, fill in the form, and submit. No account, no install, no friction — which matters when you're asking someone to do paperwork before they've even met you.

Can I re-use the form for follow-ups?

You can clone the form and send it again every quarter, or keep one form and pull the responses into a tracking sheet by client name. The comparable structure is what makes longitudinal progress visible.

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Use this health and wellness assessment form template free

Open the template, customize with AI, connect your tools, and publish — in under 5 minutes.

No signup required · Free forever plan