Wellness Consultation Form Template
The client who books a wellness consultation rarely has one problem. They sleep badly because they work late, they work late because they can’t say no, they can’t say no because everything feels urgent, and somewhere in there the movement stopped, the cooking stopped, and the joy went decorative. Ask them for their goals and you’ll get “balance” — which is a wish, not a plan.
This form turns the wish into a map. Instead of starting with food or fitness, it walks the client across every domain of their life — work, sleep, movement, relationships, stress, joy, purpose, environment — and has them rate each one honestly, before anyone meets. The conversation that follows starts where the numbers are lowest.
Eight Domains, One Honest Snapshot
Give each area its own rating from 1 to 5, asked plainly so the answers stay honest:
- Sleep — both hours and quality, because they disagree more often than clients expect
- Movement — what the body actually does in a week, not what the plan says
- Work load — sustainable, stretched, or consuming
- Relationships — fed or neglected; connection is a health behavior
- Stress capacity — how full the tank runs on a normal day
- Joy and play — the domain clients rate lowest and defend hardest
- Purpose — whether the days connect to anything that matters to them
- Environment — home, space, and whether their surroundings restore or erode them
A row of fives is rare; the shape of the scores is the consultation. Two or three domains sagging together usually tell one story, and the client has rarely seen it drawn before — which is why the form goes out before the first session rather than during it.
The Stress Map
Ratings say where; the map says why. Two open questions do the work — what currently drains them most, and what reliably restores them — answered in long text with room to be honest. The restore list becomes the coach’s raw material: the interventions that stick are built from things people already love, not things they think they should start.
One Focus, Ninety Days
Whole-life awareness with whole-life to-do lists is how wellness plans die. The form ends by narrowing: of the eight domains, which one would change the others if it moved? The client picks their focus, describes what “better” looks like in ninety days in their own words, and sets a review date. At the review, the same eight ratings get asked again — with recall information pulling their original scores forward, so progress is a before-and-after instead of a feeling.
Who Runs This Form
It suits the professional whose work spans the whole person: wellness coaches building three-month containers, retreats that want guests to arrive reflected and ready, and workplace wellbeing leads who need a snapshot that respects privacy while revealing where support is actually needed. Client details are collected with a standard contact block, everything sensitive stays in short, optional answers, and completed snapshots file in one place when the form lives on your site’s booking page. It sits in our consultation collection beside the other client-intake templates.
If your practice is specifically nutritional, the health coach consultation template goes deeper on eating and behavior change — this one deliberately stays wide.
Frequently Asked Questions
How is this different from a health coaching intake?
The health coach form dives deep on food, energy, and behavior change; this one stays deliberately wide, covering every life domain at moderate depth. Coaches who work on the whole picture start here and layer the specialist forms later.
Won't clients just rate everything a 3?
Some will — and the follow-up questions catch it. The drains-and-restores map and the 90-day focus require actual sentences, and clients who flatten the ratings usually open up in the writing. The form is designed so honesty has somewhere to go.
Should this replace the first conversation?
No — it should shorten it. The session becomes interpretation and planning instead of data collection, which is the entire point: the client paid for guidance, not a questionnaire read aloud.
What if a client's answers reveal something clinical?
The same rule that governs any wellness work: refer. Burnout that looks like depression, exhaustion that sounds like a thyroid, stress that needs more than strategy — the form’s job is to surface the pattern clearly enough that the referral is obvious and unembarrassing.