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  1. Home
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  4. Health Coaching Intake Form
Professions

Health Coaching Intake Form 2026

This ten-question intake form opens by collecting contact details — name, email, and an optional phone number — so the coach can follow up if needed. It then moves into the health picture: a multiple-choice "What are your primary health and wellness goals?" question covering eight options from weight loss to mental well-being, followed by questions on medical conditions, medications or supplements, eating habits, and weekly physical activity, each building a fuller view of the client's starting point. A rating question on current motivation to make lasting changes helps the coach gauge readiness, while an optional open-ended question on past obstacles surfaces patterns that may have held the client back before. After submitting, the respondent sees a warm confirmation telling them their coach will review the answers ahead of the first session and may reach out with any clarifying questions.

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This template is ideal for

Independent health coaches

Relies on the goals, eating habits, and activity questions to build a personalized plan before the very first session, removing the need for a lengthy intake call.

Wellness clinics and practices

Uses the medical conditions and medications questions to flag anything that requires clinical awareness before a coach makes lifestyle recommendations.

Corporate wellness programs

Draws on the motivation rating and past-obstacles question to segment participants by readiness and tailor group or one-on-one coaching accordingly.

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Dashform turns traditional form-filling into a two-way dialogue. The AI understands intent, remembers context, and asks relevant follow-up questions just like a real human conversation.

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Powerful features included

Everything you need to create amazing forms

Smart Field Detection
Automatically detects and suggests the best field types for your data.
Real-time Validation
Validate responses as users type with instant feedback and error messages.
Multi-device Support
Forms work seamlessly across desktop, tablet, and mobile devices.
Advanced Analytics
Track form performance with detailed analytics and response insights.

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