Lifestyle Questionnaire (Free Template + Filled Example)

A lifestyle questionnaire is the intake form a health or wellness coach sends before the first session to map how a client actually lives: sleep, stress, movement, food, alcohol and other substances, relationships, and what gives their days meaning. The free template below covers all seven areas in plain, client-friendly wording, adds a short safety screen that tells you when to ask for medical clearance, and closes with the client's own goal in their own words. You can copy it into any form tool today.

We make Coachful, so this is where we would send it: the short core questions go into the intake questions on your booking page, the full questionnaire is completed in the client's branded app, and every answer is stored on the client record next to the signed coaching agreement, their check-ins and their habits. You do not need Coachful to use the template, though. Below you will also find a section-by-section guide, what you must add for scope of practice and sensitive data, a filled example for a fictional client, and a comparison of ways to send and store the form.

If you coach in other niches, our wider guide to coaching intake questionnaires covers the general version. This one is built for health coaches.

Where does a lifestyle questionnaire sit in the client journey?

It belongs between the first enquiry and the first full session: after the client has booked or paid, and before you sit down together. Send it too early and prospects abandon it; send it too late and you spend the first session collecting facts instead of coaching.

A typical health coaching journey looks like this:

1. Enquiry or discovery call. The prospect books a free or paid consult. Ask three or four short questions on the booking page only: main goal, biggest obstacle, and whether a doctor is currently managing any condition.
2. Offer accepted and agreement signed. The coaching agreement states what coaching is and is not, your referral policy and your cancellation terms. Signing happens before the first call.
3. Lifestyle questionnaire. Sent right after signing, with a deadline of 48 hours before session one. This is the full template below, roughly 20 to 30 minutes for the client.
4. First session. You read the answers beforehand, pick two or three threads to explore, and agree on one or two starting habits.
5. Between sessions. Daily or weekly check-ins track the same areas the questionnaire measured (sleep hours, stress rating, movement days), so you can compare against the baseline.
6. Re-assessment. At week 6 or 12, send a shortened version of the same questionnaire and compare scores side by side.

That last step is the reason to keep the wording stable. If the client rated their stress 8 out of 10 at intake, you want to ask the identical question at week 12, not a reworded one. The first coaching session questionnaire is a lighter alternative when you only need a conversation starter rather than a baseline.

The booking-page questions and the lifestyle questionnaire do different jobs. The booking questions qualify and prepare the consult; the questionnaire builds the baseline for a paying client. Keeping them separate means a prospect is never asked about alcohol or their marriage before they have decided to work with you.

The lifestyle questionnaire template (copy and adapt)

Copy everything from the welcome note to the consent section. Replace the [bracketed] parts with your own details. Rating questions use a 0 to 10 scale so you can re-use them at re-assessment.

Welcome note (top of the form)

Hi [client first name], thank you for booking with [your business name]. This questionnaire helps me understand your day-to-day life so we can spend our first session on what matters most to you. It takes about [20 to 30] minutes. There are no right answers, and you can skip any question you would rather discuss in person. Your answers are seen only by me [and named team members, if any] and are stored [where you store them]. Please complete it by [date, 48 hours before the first session].

Coaching is not medical, psychological or nutritional treatment. If anything below suggests you should speak with a doctor or another licensed professional first, I will tell you, and we will work alongside their advice.

Section 1. About you

1. Full name, preferred name and pronouns: [ ]
2. Date of birth or age: [ ]
3. Time zone and best times for sessions: [ ]
4. Occupation and typical working hours (including shifts, nights or travel): [ ]
5. Who lives with you (partner, children, parents, housemates, pets)? [ ]
6. Emergency contact name and phone number: [ ]

Section 2. Health snapshot and safety screen

These questions help me coach safely. They are not a diagnosis. Answer yes or no, and add detail if yes.

1. Are you currently under the care of a doctor, specialist, dietitian or therapist? Who, and for what? [ ]
2. Do you have a diagnosed condition such as diabetes, high blood pressure, heart disease, asthma, a thyroid condition, an autoimmune condition or a digestive condition? [ ]
3. List any prescription medicines and supplements you take regularly, including dose if you know it. [ ]
4. Has a doctor ever told you to limit physical activity, or to exercise only under supervision? [ ]
5. In the last 12 months, have you had chest pain, fainting, dizziness that made you lose balance, or shortness of breath at rest? [ ]
6. Are you pregnant, trying to conceive, or within 12 months after giving birth? [ ]
7. Have you had surgery or a significant injury in the last 12 months? [ ]
8. Have you ever been diagnosed with, or treated for, an eating disorder? [ ]
9. Have you lost or gained more than [10 lb / 5 kg] without trying in the last six months? [ ]
10. Is there anything about your health you would like me to know that is not covered here? [ ]

Section 3. Sleep

1. On a typical work night, what time do you go to bed and what time do you get up? [ ]
2. On days off, what time do you go to bed and get up? [ ]
3. How long does it usually take you to fall asleep? [under 15 min / 15 to 30 min / over 30 min]
4. How many times do you wake during the night, and what wakes you (bathroom, children, noise, worry, hot flushes, pain)? [ ]
5. Has anyone told you that you snore loudly or stop breathing in your sleep? [yes / no / not sure]
6. Rate how rested you feel on waking: [0 = exhausted, 10 = fully refreshed]
7. What do you do in the hour before bed (screens, work email, reading, alcohol, exercise, eating)? [ ]
8. Do you nap? How often and for how long? [ ]

Section 4. Stress and mood

1. Rate your average stress level over the past two weeks: [0 = calm, 10 = overwhelmed]
2. What are your top three sources of stress right now (work, money, caregiving, health, relationship, other)? [ ]
3. Where do you notice stress in your body (jaw, shoulders, stomach, sleep, appetite)? [ ]
4. What do you currently do to unwind, and how well does it work? [ ]
5. Over the past two weeks, how often have you felt down, hopeless or lost interest in things you usually enjoy? [not at all / several days / more than half the days / nearly every day]
6. Are you currently having thoughts of harming yourself? [yes / no] If yes, please contact [local crisis line or emergency number] now, and I will also reach out to you.

Section 5. Movement and physical activity

1. In a typical week, on how many days do you do at least 30 minutes of movement that raises your heart rate (brisk walking, cycling, swimming, classes)? [0 to 7]
2. On how many days do you do strength or resistance work (weights, bodyweight, bands, heavy gardening)? [0 to 7]
3. Roughly how many hours a day do you spend sitting, including work, commuting and screens? [ ]
4. What kinds of movement have you enjoyed in the past? What have you disliked? [ ]
5. Do you have pain, stiffness or an old injury that limits how you move? Where? [ ]
6. Do you use a step counter or fitness watch? If yes, what is your usual daily step count? [ ]

Section 6. Nutrition and hydration

1. Describe what you ate and drank yesterday, from waking to bed, with rough times. If yesterday was unusual, describe a typical weekday instead. [ ]
2. How many meals do you eat on a typical day, and do you skip any regularly? [ ]
3. Who shops and cooks in your household, and how many evenings a week do you cook at home? [ ]
4. How many times a week do you eat takeaway, fast food or ready meals? [ ]
5. Roughly how much water do you drink daily? [glasses, bottles or litres]
6. Do you follow a particular way of eating (vegetarian, vegan, halal, kosher, low-carb, other) for health, ethical, cultural or religious reasons? [ ]
7. Do you have food allergies, intolerances or foods you avoid? [ ]
8. How would you describe your relationship with food: relaxed, a bit of a battle, or something you think about most of the day? [ ]
9. Do you ever eat in a way that feels out of control, or compensate afterwards by restricting, purging or over-exercising? [never / sometimes / often / prefer to discuss in person]

Section 7. Alcohol, caffeine, nicotine and other substances

1. On how many days a week do you drink alcohol, and how many drinks on a typical drinking day? [ ]
2. How often do you have six or more drinks on one occasion? [never / less than monthly / monthly / weekly / daily or almost daily]
3. How many caffeinated drinks (coffee, tea, energy drinks, cola) do you have a day, and when is the last one? [ ]
4. Do you smoke, vape or use other nicotine products? How much? [ ]
5. Do you use cannabis or any other recreational substances? How often? [optional; you may discuss this in person]
6. Have you ever felt you should cut down on any of the above, or has someone close to you raised concerns? [ ]

Section 8. Relationships and support

1. Who in your life supports your health goals? Who, if anyone, makes them harder? [ ]
2. Rate how connected you feel to the people around you: [0 = very isolated, 10 = deeply connected]
3. Are you caring for anyone (children, a parent, a partner with health needs)? How many hours a week? [ ]
4. How do meals, drinks and social plans with friends or family affect your eating, drinking and sleep? [ ]
5. Is there anything at home that makes it unsafe or difficult to make changes? [optional]

Section 9. Purpose, energy and enjoyment

1. What parts of your week give you energy? What drains it? [ ]
2. Rate how satisfied you are with how you spend your time: [0 to 10]
3. What did you love doing five or ten years ago that has dropped away? [ ]
4. If your health were no longer holding you back, what would you do more of? [ ]

Section 10. Your goals and readiness

1. In your own words, what would make the next [12 weeks / 3 months] a success? [ ]
2. Why does this matter to you now, rather than a year ago? [ ]
3. What have you tried before, and what got in the way? [ ]
4. Rate how ready you feel to change something this month: [0 = not ready, 10 = ready today]
5. Rate how confident you are that you can make that change: [0 to 10]
6. How much time can you realistically give to new habits each week? [ ]
7. How do you like to be supported between sessions (daily check-in, weekly message, accountability call, left alone until the next session)? [ ]

Section 11. Consent and acknowledgement

• I understand that health coaching is not medical care, therapy, or a substitute for advice from my doctor or other licensed professional. [tick]
• I will tell [coach name] if my health, medicines or circumstances change. [tick]
• I agree to [coach name] storing my answers in [system name] for the purpose of coaching me, as described in the privacy notice at [link]. I can ask for a copy or deletion at any time. [tick]
• Name and date: [ ]

What does each section tell you, and what should you watch for?

Each section earns its place by changing what you do in session one. The table shows why each one matters and the answers that should make you slow down.

The alcohol frequency question in Section 7 borrows its structure from widely used screening tools such as the AUDIT, but it is not a scored screen and you should not present the result as one. For movement, the WHO physical activity fact sheet is a neutral reference you can share with clients.

What must health coaches add before sending it?

Four things: your scope-of-practice line, a red-flag and referral procedure, a privacy notice that covers health data, and any wording local law requires. The template leaves gaps for all four, and they are not optional.

Scope of practice

Health coaches support behaviour change; they do not diagnose, treat, prescribe or design therapeutic diets. Bodies such as the National Board for Health & Wellness Coaching describe coaching as working alongside the client's healthcare team. Say this in the welcome note, in your coaching agreement and once more in the first session. If you also hold a licence (dietitian, nurse, physiotherapist), state clearly which hat you are wearing in this relationship.

Red flags that need clearance or referral

Write down what you will do for each one before you need it:

If you want a formal pre-exercise screen, the PAR-Q+ is a widely used published tool. It is copyrighted, so link clients to the official version or paraphrase its themes rather than pasting it into your form.

Sensitive data

This questionnaire collects health information. Under the EU and UK General Data Protection Regulation, health data is a special category that needs explicit consent or another lawful basis, a clear purpose and limited access. In the US, HIPAA applies to covered entities such as healthcare providers that bill insurance, and their business associates; many independent coaches are not covered entities, but state privacy laws may still apply. Coachful is not HIPAA-certified and does not sign a BAA, so if you are a licensed provider keeping clinical records, those belong in a clinical system. Coaching notes, goals and lifestyle answers can live in your coaching platform.

Local law and your own wording

Some states and countries restrict who can give individual nutrition advice, and some require specific disclaimers. Check the rules where you and your clients live, and have a lawyer review your agreement and privacy notice if you work across borders.

How do you run the lifestyle questionnaire in Coachful?

In Coachful the questionnaire is one step in a connected journey: booking questions, signed agreement, full questionnaire, first session, then check-ins and habits that track the same areas. Everything lands on one client record, and the client sees it all in one branded app.

Here is a short walkthrough of how intakes work, from booking to the client record:

Step 1: Add the short questions to your booking page

Coachful lets you add intake questions to a session type, so a prospect answers them while booking. Keep this to the three or four consult questions from the journey above. Intake answers are kept on the client record. The Intakes page shows upcoming intake calls and how many converted.

Step 2: Send the coaching agreement before the first call

Coaching agreements with e-signature are sent before the first call and stored on the client record. Put your scope line and referral policy in the agreement, so the client has signed it before they answer health questions. If you need agreement wording, the coaching contracts page covers it.

Step 3: Add the full questionnaire as a form

Build the template as a form or worksheet in your resources (Forms & Worksheets is one of the resource types), then deliver it to the client. You can also start from the intake form generator and paste the result in. Form responses are kept with the client's data and included in a full data export.

Step 4: What the client sees

The client opens your branded app (it runs inside the Coachful app with your branding) and sees their next session, their programs, progress and documents in one place, with pre-session work next to the session it belongs to.

Step 5: Turn the baseline into check-ins and habits

Once you know the baseline, set up morning and evening check-ins that ask the same questions: hours slept, rested rating, stress rating. Habits such as "lights out by 10:45" or "walk after lunch" track streaks, and goals show progress bars.

Multi-week programs hold the weekly goals and daily tasks, so a 12-week reset can start with sleep, add movement in week 3, and revisit nutrition in week 6. For group programs, cohort groups are created automatically on enrolment.

Step 6: Read it all on the client record

The client record holds goals, check-ins, habits, notes, intake answers, tags, payments and sessions, and Coachful marks each client as thriving, active, quiet or at risk. Michelle, the built-in AI assistant, works from that live practice data and can brief you before a session, which is handy when you have eight questionnaires to reread on a Monday.

Step 7: Payments and invoices

Payments run through your own Stripe Connect or Razorpay account, with an invoice per transaction, plus manual invoices. One-time payments, subscriptions and payment plans are all supported.

Why Coachful stands out: a free white-glove service. If you would rather not build the form yourself, go to Create, then "We'll build it for you", describe what you want (for example, "my lifestyle questionnaire as a form, plus a 12-week sleep-first program with morning and evening check-ins") and attach up to 10 files, such as this template with your edits. The Coachful team builds it inside your own account, usually within about 24 hours. Nothing gets invented: gaps such as your credentials or prices are left for you to fill. Read more about the free white-glove service.

For a real example of a wellness practice on the platform, see how Jackie Henderson runs Vibrant Mom Lifestyle on Coachful. The Coachful for health coaches page shows the full feature set, and the Fitness & Nutrition pack adds nutrition targets, meal plans, private progress photos and weekly check-ins if you also coach food and training.

What is the best way to send and store a lifestyle questionnaire?

Use a tool that keeps the answers next to the rest of the client's record, so you can compare them against check-ins later. A PDF or a standalone form works for a handful of clients, but the answers end up scattered across inboxes and drives. Prices below are as listed in October 2026.

A short note on the other tools

Each of these can hold a lifestyle questionnaire; they differ in what sits around it. Practice Better is practice management for wellness and nutrition practitioners, with charting and telehealth; evergreen programs, portal branding and SMS start on its Plus plan ($99/mo as listed). Paperbell covers booking, packages, payments, contracts and a simple website, and its older profile notes no habit or goal tracking. Dubsado is a client-workflow CRM, and says it does not include website building and is not an email marketing platform. Quenza focuses on activities, worksheets and a client app, with payments and invoicing marked as planned. HoneyBook and Satori also offer forms and contracts. If you are weighing HoneyBook, our HoneyBook pricing breakdown covers its plans, and the comparison hub covers the rest.

What does a completed lifestyle questionnaire look like?

Below is an example for a fictional client, written to show the level of detail you are hoping for. The person, answers and numbers are invented for illustration.

Example only. Fictional client: Priya, 44, secondary school teacher.

About you: Teaches 8:00 to 16:00, marks papers most evenings until 21:30. Lives with a partner and two children, aged 9 and 13. Time zone GMT; prefers Tuesday or Thursday evenings.

Health snapshot: Under GP care for borderline high blood pressure, no medicine yet; GP suggested more exercise and less salt. Takes vitamin D in winter. No chest pain or fainting. Not pregnant. No surgery. No eating disorder history. Gained about 6 kg over three years.

Sleep: Bed at 23:45, up at 6:15 on weekdays; weekends 00:30 to 8:30. Takes 30+ minutes to fall asleep. Wakes once or twice, usually worrying about work. Partner says snoring "sometimes". Rested rating 3 out of 10. Scrolls on phone in bed. No naps.

Stress and mood: Stress 8 out of 10. Sources: workload, a parent who needs more help, money. Feels it in shoulders and jaw. Unwinds with a glass of wine and TV ("works for an hour"). Felt down "several days" in the last two weeks. No thoughts of self-harm.

Movement: 1 day a week of 30-minute activity (Saturday walk). 0 strength days. Sits about 9 hours a day including marking. Used to love swimming. Sore lower back after long marking sessions. About 4,500 steps a day on her phone.

Nutrition: Yesterday: coffee at 6:30, skipped breakfast, biscuits at 10:30 break, sandwich at 12:40, crisps at 15:30, pasta with the family at 18:30, toast and cheese at 22:00 while marking. Cooks four nights a week. Takeaway twice a week. Drinks about 1 litre of water. No dietary restrictions. Relationship with food: "a bit of a battle in the evenings".

Substances: Wine 4 nights a week, 2 glasses each time. Six or more drinks "less than monthly". 3 coffees, the last at 15:00. Does not smoke. No other substances. Has wondered about cutting down on weekday wine.

Relationships: Partner supportive but works late. Connection 5 out of 10. About 6 hours a week helping her mother. Friday drinks with colleagues make Saturday mornings slow.

Purpose: Energy from teaching and her children's football. Drained by marking and admin. Satisfaction 4 out of 10. Used to swim twice a week and sing in a choir.

Goals: "Wake up feeling human, and have my blood pressure better at the next GP check in March." Why now: "the GP appointment scared me." Tried calorie apps twice; quit after three weeks both times. Readiness 8, confidence 4. Can give about 3 hours a week. Wants a short daily check-in and a weekly message.

How a coach might read it (example): nothing here stops coaching, but the GP is already involved with blood pressure, so any change in activity or salt stays in line with that advice, and the client should mention the coaching to the GP. Possible snoring plus poor sleep is worth raising with the GP too. Readiness 8 and confidence 4 says the first habit must be small: a phone charger outside the bedroom and lights out by 23:15 for two weeks, tracked with an evening check-in. Wine on weeknights links to both sleep and stress, so it becomes a conversation in session two rather than a rule in session one. Swimming is the obvious movement lever once sleep improves.

What are the most common mistakes with a lifestyle questionnaire?

Most problems come from asking too much, too early, or collecting answers you never use.

• Sending it before the client has committed. Health and alcohol questions in a free consult form feel intrusive. Keep the booking page short.
• Asking clinical questions you cannot act on. Blood test results and diagnosis histories invite you outside your scope. Ask who manages the condition, not for the clinical detail.
• No plan for red flags. If a client ticks "yes" to self-harm on a Friday night, you need to know already what you will do and who you will contact.
• Vague rating scales. "How is your stress?" cannot be compared at week 12. Use 0 to 10 with labelled ends.
• Changing the wording at re-assessment. Use the same questions so the comparison means something.
• Storing it in your inbox. Health answers in email threads are hard to protect and easy to lose. Keep them on the client record with limited access.
• Not reading it before session one. Clients notice. Quote one of their own phrases back to them in the first ten minutes.
• Making every section mandatory. Let clients skip sensitive questions and discuss them in person. You will get more honest answers.
• Copying an official screening form verbatim. Tools like the PAR-Q+ are copyrighted; link to them or paraphrase.

Other templates in this series cover different settings: the group coaching intake questionnaire for cohort programs and the relationship coaching intake questionnaire if you coach couples. For more forms in one place, see coaching forms and questionnaires.

Is this template legal or medical advice?

No. This template and article are general information for coaches, not legal, medical or financial advice. Laws on health data, nutrition advice and coaching disclaimers vary by country and state. Before you use it with clients, have a lawyer review your coaching agreement, privacy notice and consent wording, and if you plan to coach clients with medical conditions, ask a clinician you trust to review your red-flag list and referral procedure.

Lifestyle questionnaire FAQ

How long should a lifestyle questionnaire be?

Aim for 20 to 30 minutes of client time, which is roughly the length of the template above. Anything longer and completion drops; anything much shorter and you will spend session one gathering basics. Cut questions you never use after your first ten clients.

When should I send the lifestyle questionnaire?

After the client has signed the coaching agreement and paid, with a deadline about 48 hours before the first session. That gives you time to read it and spot anything that needs medical clearance before you meet.

Can I use this template for free?

Yes. The template is free to copy, edit and use with your own clients. Replace the bracketed parts, add your scope line and privacy notice, and have a lawyer review the consent wording for your location.

Is a lifestyle questionnaire the same as a health history form?

No. A health history form collects clinical detail for a licensed provider. A lifestyle questionnaire maps daily habits and goals, with a short safety screen that tells you when to ask for clearance. If you are not licensed, avoid turning it into a medical history.

What should I do if a client answers yes to a red flag?

Pause any change related to that answer, tell the client why, and ask them to speak with their doctor or the relevant professional. Note the conversation on their record. For any mention of self-harm, follow your written safety procedure the same day and share a crisis line.

Can I store health answers in Coachful?

Coaching answers such as goals, habits and lifestyle questionnaire responses can be stored on the client record, and Coachful is GDPR-ready. Coachful is not HIPAA-certified and does not sign a BAA, so licensed providers should keep clinical records in a clinical system.

How do I re-use the questionnaire for progress checks?

Send a shortened version at week 6 or 12 with the same rating questions: rested on waking, stress, connection, satisfaction, readiness and confidence. Compare the numbers with the client and let them explain what changed.

Will Coachful build my questionnaire for me?

Yes. The white-glove build service is free on every plan: request a form or worksheet from Create, then "We'll build it for you", attach this template with your edits, and the team builds it in your account, usually within about 24 hours. They will not invent credentials or prices; those gaps are left for you.

What does Coachful not do for health coaches?

It does not sync with Garmin, Fitbit, Whoop or Oura, Apple Health sync is not publicly available, and it does not include stock exercise videos (you attach your own). It is not built for clinical record-keeping or insurance billing, and it has no PayPal payments.

How do I get started with Coachful?

Start a free trial, then ask for the free white-glove build to set up your questionnaire, agreement and first program. Coachful is for coaches who deliver programs as well as sessions, and it replaces separate booking, payment, form and program tools with one login (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).