Holistic Intake Form: Copy-and-Paste Template for 2026
A holistic intake form is the questionnaire a new client completes before the first session so you can see the whole person: health history, sleep, food, movement, stress, relationships, environment, purpose and what they want to change. Below is a free holistic intake form you can copy today. It has twelve numbered sections written for holistic health coaches, with [bracketed] fill-ins for your practice details, a consent block and a short list of answers that mean you pause and refer the client to a clinician.
We make Coachful, a coaching platform where this template can live inside your client journey: the client answers intake questions when they book, signs your coaching agreement before the first call, and every answer is stored on their client record next to their goals, habits and check-ins. You can also paste the template into a document or a form builder; the comparison further down covers both routes honestly.
What is in this holistic intake form template?
The template covers twelve areas, from contact details to consent, in the order a client finds easiest to answer: quick facts first, the personal questions in the middle, and the agreement at the end. Copy everything between the headings below, replace each [bracket], and delete any question you would not act on.
Holistic health coaching intake form: [Your practice name]
Thank you for choosing to work with me. This form helps me understand your life as a whole before we meet. It takes about 20 to 30 minutes. Answer what you are comfortable sharing; you can skip any question and we can talk about it in person. I am a health coach, not a doctor, dietitian or therapist, and nothing in our work replaces care from your own healthcare providers.
- About you
- Full name, and the name you would like me to use:
- Pronouns (optional):
- Date of birth:
- Email and mobile number:
- City and time zone:
- Preferred way to reach you between sessions (email, app message, text):
- Occupation and typical working hours:
- Who lives with you (partner, children, parents, housemates, pets)?
- Emergency contact name, relationship and phone number:
- What brings you here
- In your own words, what made you reach out now?
- What are the top three things you would like to be different in [12 weeks / 6 months]?
- If our work goes well, what will a normal Tuesday look like for you?
- What have you already tried (programs, diets, practitioners, apps, books)? What helped, and what did not?
- On a scale of 1 to 10, how ready do you feel to make changes right now? What would move that number up by one?
- Your healthcare team and health history
- Primary doctor or nurse practitioner, and date of your last check-up:
- Other practitioners you see now (for example a naturopath, acupuncturist, chiropractor, therapist, dietitian, osteopath):
- Diagnosed conditions, past or current (for example thyroid, diabetes, heart, autoimmune, digestive, hormonal, mental health):
- Surgeries, hospital stays or major injuries, with approximate year:
- Known allergies or intolerances (food, medicine, environmental):
- Are you pregnant, trying to conceive, breastfeeding, or within a year of giving birth? (yes / no / prefer to discuss)
- For those who menstruate: is your cycle regular, and are you in perimenopause or menopause?
- Family history you think is relevant (for example heart disease, diabetes, cancer, autoimmune conditions):
- Medications and supplements
- Prescription medications, dose and what each is for:
- Over-the-counter medicines you take regularly:
- Supplements, herbs, teas, tinctures or powders, with brand and amount if you know it:
- Has a clinician asked you to avoid any food, herb or supplement?
I do not prescribe, change or stop medication or supplements. I ask so I never suggest something that conflicts with what your healthcare team has advised.
- Body and energy
- How would you describe your energy across a typical day (morning, mid-afternoon, evening)?
- Digestion: how often are you troubled by bloating, reflux, constipation or loose stools? (never / sometimes / often / daily)
- Any pain, stiffness or symptoms that affect daily life? Where, and since when?
- Headaches, dizziness or skin changes you have noticed recently:
- Anything about your body you would like me to know that is not asked here:
- Food and drink
- Describe a typical day of eating, from waking to bedtime (times, meals, snacks, drinks):
- How many glasses of water, cups of coffee or tea, and alcoholic drinks in a usual week?
- Do you follow a particular way of eating (for example vegetarian, vegan, gluten-free, low FODMAP, religious or cultural practice)? By choice or on advice?
- Who shops and cooks in your home, and how much time do you have for it?
- How do you feel about food right now (relaxed, confused, guilty, bored, in control, out of control)?
- Have you ever been diagnosed with, or treated for, an eating disorder? (yes / no / prefer to discuss)
- Sleep and rest
- Usual bedtime and wake time on work days and days off:
- How long does it take you to fall asleep, and do you wake in the night?
- Do you wake feeling rested? (rarely / sometimes / usually)
- Screens, caffeine or alcohol in the two hours before bed?
- Has anyone told you that you snore loudly or stop breathing in your sleep?
- Movement
- What movement do you do in a usual week (walking, yoga, strength, sport, dance, gardening)? How often and how long?
- What kind of movement do you enjoy, or used to enjoy?
- Has a doctor ever limited your physical activity, or do you get chest pain, faintness or unusual breathlessness when active?
- Stress, mood and mind
- Main sources of stress right now (work, money, caregiving, relationships, health, other):
- Rate your average stress over the past month from 1 (calm) to 10 (overwhelmed):
- What helps you settle when you are stressed? What do you reach for that does not help?
- Are you currently working with a therapist, counsellor or psychiatrist?
- In the past two weeks, have you had thoughts of harming yourself or that you would be better off not here? (yes / no) If yes, please contact [local crisis line or emergency number] now; you do not need to wait for our session.
- Relationships, environment and purpose
- Who supports you, and who finds your changes hard?
- How do you feel about your home and work environment (light, noise, clutter, time outdoors, air quality)?
- Is there a spiritual, faith, nature or creative practice that matters to you? Would you like it to be part of our work?
- What gives you a sense of meaning or purpose at the moment?
- What is one thing in your life that is going well and that you want to protect?
- How you like to be coached
- Do you prefer gentle encouragement, direct challenge, or a mix?
- How much support would you like between sessions (daily check-in, weekly check-in, only in sessions)?
- What usually gets in the way when you try to change a habit?
- Anything about your culture, identity, body or past experiences with practitioners that you would like me to keep in mind?
- Consent and agreement
- I understand that [Your name] is a health coach and does not diagnose, treat, cure or prevent any disease, prescribe medication or supplements, or provide medical, nutrition therapy or mental health treatment.
- I will keep my own healthcare providers informed and will consult them before making changes to medication, diet or activity that could affect a health condition.
- I understand that if my answers or anything I share suggest I need medical or mental health care, [Your name] may pause coaching and recommend I see a qualified professional.
- I consent to [Your practice name] storing the information on this form to provide coaching, as described in the privacy notice at [link to privacy notice]. I can ask to see, correct or delete it at any time by emailing [your email].
- I have read the coaching agreement covering fees, cancellations ([24 / 48] hours notice) and confidentiality, and I agree to it.
- Signature: ______________ Date: ______________
Coach-only review box (do not send to the client): Red flags answered yes? [ ] none [ ] clearance requested from clinician on [date]. Medications or supplements to keep in mind: ______. Top three goals in client's words: ______. First session focus: ______.
Why does each section matter, and what should you watch for?
Every section earns its place by changing what you do in the first session or by telling you when coaching is not the right support yet. The table explains the purpose of each and the answers that deserve a second look.
| Section | Why it matters | What to watch for |
|---|---|---|
| 1. About you | Practical contact, time zone and household context; the emergency contact is there in case something happens during a live session. | Caregiving loads and long shifts shape what is realistic. A client in a different time zone needs booking reminders in their own time. |
| 2. What brings you here | Captures goals in the client's words, which you will reuse in programs and check-ins. | Goals that are really medical outcomes ("reverse my diabetes") need reframing into behaviours you can coach, with their doctor managing the condition. |
| 3. Healthcare team and history | Shows who else is involved and which conditions limit your suggestions. | No primary doctor at all, a recent diagnosis, pregnancy, or symptoms that have never been checked. Suggest a check-up before you start. |
| 4. Medications and supplements | Prevents you from suggesting a herb, tea, fast or food change that clashes with treatment. | Blood thinners, blood pressure, diabetes, thyroid, psychiatric or hormonal medication combined with a long supplement list. That conversation belongs with their prescriber or pharmacist. |
| 5. Body and energy | Gives you the client's baseline so you can show progress later. | Unexplained weight loss, blood in stool, persistent pain, new severe headaches or fainting. Refer before coaching. |
| 6. Food and drink | Reveals the real eating pattern and the practical limits (budget, cooking time, family). | Any history of disordered eating means avoiding restrictive plans and checking that a treating clinician is involved. Heavy alcohol use is a referral conversation. |
| 7. Sleep and rest | Sleep often moves energy, mood and food choices more than any single habit. | Loud snoring with pauses in breathing, or chronic insomnia, should be checked by a doctor. |
| 8. Movement | Shows what the client enjoys, which predicts what they will keep doing. | Chest pain, faintness or breathlessness with activity, or a doctor's restriction, means written clearance before you suggest new exercise. |
| 9. Stress, mood and mind | Stress patterns are central to holistic work, and this section tells you whether a therapist is already in the picture. | A yes to the self-harm question means you act the same day: share crisis resources and do not continue as if it were a coaching goal. |
| 10. Relationships, environment, purpose | The parts that make the form holistic; they often explain why earlier attempts stalled. | Signs of an unsafe relationship need a careful, private follow-up and relevant support numbers, not a habit plan. |
| 11. How you like to be coached | Sets the tone and the between-session support from day one. | A client who wants daily contact on a plan that includes weekly check-ins; agree expectations before they turn into frustration. |
| 12. Consent and agreement | Records scope, data consent and business terms in one signed place. | An unsigned form or a client who crosses out the scope line. Do not start sessions until both are sorted. |
If you want help choosing which questions to keep, our list of coaching intake form questions with examples explains the reasoning behind common wording, and the health coaching intake form template is a shorter version for coaches with a narrower focus.
What must holistic health coaches add before using it?
Four things: a clear scope-of-practice line, a referral procedure, a privacy notice that matches how you store health data, and a check against the law where you and your clients live. The template has placeholders for each, but they only work if you fill them in for your own practice.
Scope of practice
Coaching is not treatment. A holistic health coach supports behaviour change, accountability and self-knowledge; diagnosis, prescribing and therapy belong to licensed clinicians. The National Board for Health & Wellness Coaching publishes a scope of practice for board-certified coaches that is a useful model even if you hold a different credential. If you also hold a clinical licence (for example as a nurse, dietitian or naturopathic doctor), say which hat you wear in this relationship, because that changes your record-keeping duties. Our guide to becoming a holistic health coach covers training and scope in more depth.
Holistic clients often combine approaches. The US National Center for Complementary and Integrative Health explains the difference between complementary, alternative and integrative health, which helps you describe your role without implying you replace conventional care.
Red flags that need a clinician first
Write your referral rule into the coach-only box and follow it every time. A reasonable starting list, based on the kinds of questions found in common pre-activity screening tools such as the PAR-Q+ (paraphrased here, not reproduced), plus issues specific to holistic work:
| Answer on the form | What you do |
|---|---|
| Chest pain, fainting, dizziness or unusual breathlessness, at rest or during activity | Pause any movement suggestions and ask for written clearance from their doctor. |
| A doctor has said the client should only do medically supervised activity | Coach around that limit only, with the clinician's guidance in writing. |
| Pregnancy or recent birth | Get clearance before any change to food, fasting, herbs or exercise. |
| Unexplained weight loss, blood in stool or urine, a lump, or symptoms never examined | Refer for a medical appointment before coaching starts. |
| Current or past eating disorder | No restrictive plans; confirm a treating clinician is involved, or refer. |
| Thoughts of self-harm, or an untreated mental health condition | Share crisis resources the same day and refer to mental health care. |
| Several prescription medications plus supplements | Send interaction questions to their prescriber or pharmacist. The NIH Office of Dietary Supplements has fact sheets you can point clients to. |
| A diagnosed condition such as type 1 diabetes, kidney or heart disease | Ask the clinician which changes are safe before suggesting food or activity changes. |
Clearance means a short note or message from the clinician saying coaching can go ahead and naming any limits. Record the date in the coach-only box.
Sensitive data and local law
Health answers are sensitive personal data. In the EU and UK, data about health is a special category under Article 9 of the General Data Protection Regulation, so you need explicit consent, a clear privacy notice and a reason for every question you keep. In the US, HIPAA usually applies to covered entities such as healthcare providers who bill insurance electronically and their business associates; the HHS HIPAA pages explain who is covered. Most independent coaches are not covered entities, but state privacy laws may still apply, and if you are a licensed clinician as well, your duties change. Ask an attorney where you practise.
Coachful is GDPR-ready but not HIPAA-certified and does not sign a BAA, so it is a coaching record, not a clinical one. If you keep clinical notes, keep them in a clinical system built for that purpose.
What does a completed holistic intake form look like?
Here is a short filled example for a fictional client, so you can see the level of detail that is useful. This is an example; the person and answers are invented.
Example client: "Maya R.", 41, project manager, two children, [city withheld].
What brings you here: "I'm tired by 2pm every day and snap at the kids by 6. I want steady energy, to sleep through the night and to feel like I have some time that is mine." Readiness: 7. "It would be an 8 if I knew where to start."
Healthcare team: GP, last check-up 14 months ago. Sees an acupuncturist monthly. Hypothyroidism diagnosed 2021. No surgeries. Not pregnant. Perimenopause suspected, not confirmed.
Medications and supplements: Levothyroxine each morning. Magnesium at night, a multivitamin, ashwagandha capsules "a friend recommended".
Food and drink: Coffee only until noon, skips lunch on meeting days, large dinner at 8pm, two glasses of wine most evenings. Cooks for the family; 20 minutes on weeknights.
Sleep: Bed 11:30pm, wakes at 3am most nights, scrolls the phone in bed.
Movement: Walks the dog 20 minutes. Loved yoga before children.
Stress, mood: 8 out of 10, work and caregiving for her father. No therapist. Self-harm question: no.
Purpose: "Gardening and being outside. I haven't done either this year."
Coaching style: Direct, with a short daily check-in.
Coach-only review for the example: No red flags requiring clearance to start. Ashwagandha alongside thyroid medication goes on the list for Maya to raise with her GP or pharmacist before the coach suggests anything else in that area. Overdue check-up and suspected perimenopause: encourage a GP appointment, coaching continues. First session focus: lunch on meeting days, a phone-free wind-down, and one weekend morning outdoors. Goals in her words go straight into a 12-week program with a morning energy check-in and an evening sleep habit.
Notice what the coach did not do: no supplement advice, no thyroid commentary, no diet plan. The form made the boundaries obvious and gave a concrete, coachable starting point.
How can you send and store a holistic intake form?
You can send it as a file, as an online form, through an e-signature tool, or inside practice software. The deciding question is where the answers end up: next to the rest of your client's coaching, or in a separate folder you must remember to check.
| Option | How the client completes it | Where answers are stored | Signing | Price (as listed in October 2026) |
|---|---|---|---|---|
| Coachful | Intake questions on the booking page, plus forms and worksheets in their branded client home and app | On the client record with goals, habits, check-ins, sessions, notes and payments | Coaching agreement with e-signature sent before the first call, stored on the client record | Lite: $29/month for up to 5 clients |
| PDF or Word file | Downloaded, filled in, emailed or printed back | Your inbox or file storage; you copy answers by hand | Print and sign, or a separate tool | No cost beyond software you already have |
| Google Forms or Docs | A link to an online form or shared document | A spreadsheet or document in your Google account | Not built for signatures; add a checkbox or a separate tool | Included with a Google account; check your workspace terms for health data |
| A standalone e-signature tool | A document sent for completion and signature | In that tool's account, as a signed PDF | Yes, that is its job | Varies by provider and volume |
| Practice Better | Forms in a client portal, part of practice management for wellness practitioners | Inside Practice Better, alongside charting | Forms and documents in the portal | Sprout $0/mo (3 clients); Starter $35/mo; Professional $69/mo |
| Dubsado | Forms sent through client workflows | Inside Dubsado's client CRM | Contracts included | Starter $35/mo; Premier $55/mo |
| Paperbell | Forms in a client portal during booking and packages | Inside Paperbell | Contracts included | Single plan $97/mo |
Files and Google Forms work when you have two or three clients and a reliable habit of copying answers into your notes. The weakness appears later: the intake lives in one place, the signed agreement in another, check-ins in a messaging app and invoices in your payment processor. Practice Better and Dubsado both document form tools, and Practice Better's charting suits practitioners who need clinical-style notes; neither is centred on delivering a coaching program with habits and check-ins the way a holistic coach usually works. For a wider comparison, see intake form software for holistic health coaches.
How do you set up this intake form in Coachful, step by step?
In Coachful the intake is the first step of a longer journey, not a standalone document: the client books, answers your intake questions, signs the agreement, and then starts a program with habits and check-ins that grow out of those answers. Here is how to set it up and what the client sees at each step.
This short walkthrough shows the Intakes area before the steps below.
Step 1: Put the essential questions on your booking page
Booking pages in Coachful include intake questions, so the first five or six questions (name, goals in their own words, current healthcare team, pregnancy, and the self-harm screen) can be answered at the moment someone books a discovery or first session. Availability rules, buffers, minimum notice and time-zone detection handle the scheduling side, and the client gets email reminders, plus SMS and WhatsApp reminders once messaging is enabled. Every booked intake call appears on the Intakes page with its status, so you can see who has booked, who is upcoming and who converted.
Step 2: Add the full form as a worksheet
The rest of the template works better as a longer form the client completes at home. Forms & Worksheets is one of the resource types in Coachful, delivered into the client's branded home and app. Keep sections 3 to 11 here, so the booking step stays short.
Step 3: Send the coaching agreement before the first call
Section 12 belongs in your signed agreement. Coachful sends coaching agreements with e-signature before the first call and stores the signed copy on the client record. If you already have a signed PDF from elsewhere, the Agreements tab accepts it. See coaching contracts in Coachful for what the agreement can cover.
Step 4: Review the answers on the client record
Intake answers sit on the client record next to goals, check-ins, habits, notes, tags, payments and sessions. Fill in your coach-only review in the client's notes, and tag any client who needs clinician clearance so they are easy to find. Before the first session, Michelle, the built-in AI assistant, can brief you from the live data in that record, and the client's status (thriving, active, quiet or at risk) keeps updating as the work goes on. If you want to sort answers into priorities automatically, our guide to automating intake form scoring covers the approach.
Step 5: Turn the answers into a program, habits and check-ins
This is where a holistic intake pays off. Goals written in section 2 become goals with progress bars; sleep and stress answers become a morning check-in and an evening check-in; the movement a client enjoys becomes a habit with a streak. Multi-week programs hold the weekly goals and daily tasks, and enrolling a client in a group program creates the cohort group automatically.
On the client side, the habit tracker shows each habit with its count, and the program view shows the current week and the other members of a group.
Step 6: Show the client one place for everything
The client sees their next session, any required pre-session item (such as the intake worksheet), their programs, progress and documents in one coaching hub, under your branding inside the Coachful app. They do not need separate logins for forms, signing and the program.
Step 7: Take payment and send the invoice
Payments run through your own Stripe Connect or Razorpay account, with an invoice for each transaction and the option to create manual invoices. Coachful charges no platform fee on those payments; only Stripe or Razorpay processing applies. Payment plans and subscriptions suit holistic packages that run for several months.
What is Coachful, and who is it for?
Coachful is a coaching platform for coaches who deliver programs, not just sessions. One subscription covers booking, payments, contracts, programs with habits and check-ins, courses, a community, a website with funnels and email, and an AI assistant, with one login for you and one branded app for your clients. It suits solo holistic health coaches, coaches growing into a small team, and anyone replacing four to six separate tools.
What it does not do: it is not HIPAA-certified and does not sign a BAA, so it is not for clinical record-keeping or insurance billing. There is no PayPal, no permanent free plan, and no Garmin, Fitbit, Whoop or Oura sync. Plans are flat and monthly, lower plans cap the number of clients and Pro is unlimited (current plans: Lite: $29/month for up to 5 clients; Solo: $49/month for up to 20 clients; Pro: $99/month with unlimited clients; Studio: $199/month with unlimited clients). To start, take a free trial and ask the team to build your setup for you. More detail for this niche is on the Coachful for health coaches page and in our roundup of software for holistic health coaches.
Why Coachful stands out: a free white-glove service. From Create, choose "We'll build it for you · FREE", describe what you need (a form or worksheet, a program, a website, a funnel, an email sequence and more), attach up to 8 reference links and up to 10 files, and the Coachful team builds it inside your own account, usually within about 24 hours. You could paste this holistic intake form into the request and have it set up as a worksheet with a matching welcome flow. Nothing gets invented: gaps such as your credentials or prices are left for you to fill. A menopause and midlife health coach who started from nothing, for example, received a five-page site in sage and cream with every button leading to a free 20-minute consultation. Read more about the free white-glove service.
What mistakes do coaches make with holistic intake forms?
The most common mistake is asking for clinical detail you are not trained to interpret and then doing nothing with it. Others are quieter but cost you clients or trust.
- Making it too long for the booking step. Fifty questions before a discovery call loses people. Keep five or six at booking and send the rest after they commit.
- Asking questions you will not use. If you never look at lab values or a full symptom checklist, do not collect them. Under GDPR, every question needs a purpose, and an unused health detail is a liability.
- No referral rule. A red flag answered yes, with no written plan for what happens next, is worse than not asking. Decide your rule now and record what you did.
- Commenting on medication or supplements. Even "you could probably drop that" is outside scope. Send the question back to the prescriber or pharmacist.
- Treating the form as a one-time document. Revisit section 2 and section 9 at week six and at the end of a program. Progress is easier to see against the client's own words.
- Leaving the answers in an inbox. If the intake is not where you prepare for sessions, you will stop reading it after the first call.
- Skipping the privacy notice. A consent line that links to nothing does not tell the client how their data is stored, for how long, or how to delete it.
- Using generic wellness wording. Questions about environment, purpose and practices are what make the form holistic; a template copied from a gym will miss them. The nutrition intake form and personal training intake form show how much the focus changes by niche.
Is this template legal or medical advice?
No. This holistic intake form is a practical starting point, not legal, medical or financial advice, and it does not make anyone a clinician. Laws on health data, consent, coaching and the use of titles vary by country, state and province. Have a local lawyer review your consent wording, privacy notice and coaching agreement before you use them, and ask a clinician you trust (for example a GP or registered dietitian you refer to) to review your red-flag list and referral process. If you hold a clinical licence, check with your licensing board how coaching records fit your obligations.
Frequently asked questions
What should a holistic intake form include?
Contact and emergency details, goals in the client's words, healthcare team and history, medications and supplements, energy and digestion, food, sleep, movement, stress and mood, relationships, environment and purpose, coaching preferences, and signed consent. The template above covers all twelve, and you can remove anything you would not act on.
How is a holistic health intake form different from a standard health coaching form?
It looks beyond food and exercise to environment, relationships, spiritual or creative practice and sense of purpose, and it asks about the other practitioners a client sees, such as acupuncturists or naturopaths. The scope and red-flag rules stay the same: you coach behaviour, and clinicians treat conditions.
Is this holistic intake form template free?
Yes. You can copy, edit and use the template in your practice. Replace every bracket, add your privacy notice link, and have a local lawyer review the consent section before you send it.
When should a client complete the intake form?
Ask a few essential questions when they book, and send the full form after they commit and before the first paid session. That keeps the booking quick and gives you time to read the answers and request clinician clearance if needed.
Can I use this form to decide on supplements or diets for clients?
No. A health coach should not prescribe, change or stop supplements, herbs or medication, and should not design medical nutrition therapy. Use the answers to avoid conflicts with what the client's healthcare team advises, and send questions about interactions to their prescriber or pharmacist.
Do I need to be HIPAA compliant as a holistic health coach?
HIPAA usually applies to covered entities such as providers who bill insurance electronically, and to their business associates. Many independent coaches are not covered, but state privacy laws and GDPR may still apply, so ask a lawyer. Coachful is not HIPAA-certified and does not sign a BAA, so keep clinical records in a clinical system.
Where are intake answers stored in Coachful?
On the client record, next to goals, check-ins, habits, notes, tags, payments and sessions. Answers to intake questions asked at booking appear there too, and a full client data export as a ZIP includes form responses.
What is Coachful's free white-glove service?
It is a build service included on every plan: you describe what you need, such as an intake worksheet, a program or a website, attach links and files, and the Coachful team builds it inside your account, usually within about 24 hours. It does not invent credentials, testimonials or prices, and it does not include video recording, logo design or ad management.
How often should I update a client's intake?
Review it at the halfway point and at the end of every program, and any time the client reports a new diagnosis, pregnancy, medication change or major life event. A quick check-in asking "has anything changed in your health or medication?" catches most of it.
Can I generate a customised version of this form?
Yes. The intake form generator builds a version from your niche and focus, and the guide to coaching forms and questionnaires shows how forms fit into the rest of your client journey.
