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Health and lifestyle assessment form

health and lifestyle assessment form

Coaching businesses, listen up!

If you're a Life Coach, Business Coach, or Consultant, this Health and Lifestyle Assessment Form is tailored just for you.

It's designed to gather insightful information about your clients’ health and lifestyle habits. This wealth of data can help you create personalized coaching programs that truly resonate with your clients.

So, let's dive into creating powerful connections with your clients.

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Questions to include on your Health and lifestyle assessment form

1. Personal Information

We need some basic information to get started. This will help us personalize your coaching experience.

  • What is your name?
  • What is your gender? (Male, Female, Prefer not to say)
  • What is your age?
  • Please provide your contact details.
  • What is your current occupation?

2. Health Status

To better tailor your coaching sessions, it's important for us to understand your current health condition.

  • Do you have any known medical conditions? (Yes, No)
  • If yes, please specify.
  • When was your last medical check-up?

3. Lifestyle and Habits

Understanding your lifestyle and habits helps us tailor programs that are realistic and achievable for you.

  • How many hours of sleep do you get on an average night?
  • How often do you exercise in a week?
  • How would you rate your stress level on a scale of 1-10? (1 being very low and 10 being very high)

This group also includes assessing your dietary habits which is crucial in determining a suitable coaching program.

  • How many meals do you eat in a day?
  • Would you describe your eating habits as healthy? (Yes, No, Sometimes)
  • Do you smoke? (Yes, No)
  • Do you drink alcohol? (Yes, No, Occasionally)

4. Goals

Knowing your goals helps us to customize your coaching to suit your needs.

  • What are your top three health goals?
  • What are the main obstacles to achieving these goals?
  • Are there specific areas you want help with?

5. Coaching Preference

This will give us an insight into how we can communicate and interact with you effectively.

  • What is your preferred coaching style? (Directive, Non-Directive, Supportive, Challenging)
  • Would you prefer sessions in-person, online or both? (In-person, Online, Both)
  • How often would you like to have your coaching sessions?

The style preference and frequency of sessions will help us match you to a coach that fits your needs and preferences while still challenging you to reach your goals.

Other question ideas

When you are creating your Health and lifestyle assessment form, here are some additional questions you may want to consider. These won't apply in every case, but should give you some ideas as you build out your form.
  • How many hours a day do you spend on technology devices?

    • This will give an insight into potential sedentary lifestyle habits or issues with time management.
  • What's your level of contentment with your current lifestyle on a scale of 1-10?

    • This will help gauge the level of satisfaction or dissatisfaction with the current lifestyle which can be a motivating factor for change.
  • Do you have a family history of chronic diseases? (Yes, No)

    • This information can highlight potential health risks and areas to focus on in coaching sessions.
  • What do you do for relaxation or stress-relief?

    • This offers insight into current coping mechanisms and possible areas for enhancement.
  • If money wasn't a factor, what changes would you make to your health and lifestyle?

    • This can reveal true aspirations and desires, identifying potentially unexplored goals.
  • How confident are you in achieving your health and lifestyle goals on a scale of 1-10?

    • This can give a sense of the individual’s self-efficacy and belief in their ability to make changes, which can impact their motivation and progress.
  • Who or what is your biggest source of support in life?

    • Understanding the person's support system can help tailor strategies that leverage these support sources, or identify areas where additional support may be needed.
  • Have you ever worked with a coach before? (Yes, No)

    • This can provide insights into past experiences, expectations, and potential challenges or successes in the coaching relationship.
  • How would you feel if you don't make any changes to your current lifestyle?

    • This can gauge the level of urgency or importance that the individual places on making changes to their lifestyle.
  • What is the one habit you most want to change?

    • This can help identify priority areas for the coaching intervention.

Things to consider

  1. Privacy Considerations - Make sure your form is compliant with data privacy laws in your jurisdiction. Assure your users that their information will be kept confidential.
  2. Mobile-Friendly Design - Many users may be accessing the form on their phones. Ensure the form is responsive and fields are easy to fill out on smaller screens.
  3. Clear Instructions - Be clear and concise with your question wording to avoid confusion. Avoid industry jargon as much as possible.
  4. Use of Conditional Logic - If a question is not relevant based on a previous response, the form should hide it to make the process quicker and smoother. This is known as conditional logic.
  5. Required Fields - Mark fields that must be filled for the form to be submitted. However, try to keep these to a minimum to avoid discouraging users from completing the form.
  6. Validation - Use form validation for fields such as email address or dates to ensure the data entered is in the correct format.
  7. Progress Indicator - If the form is long, consider adding a progress bar or indicator. This helps users know how much of the form is left and can improve completion rates.

How to create your Health and lifestyle assessment form

Now that you know what questions you should include, it's time to build your form!

The only problem is that traditional forms tools are inefficient.

People will forget to fill out your form. They'll get stuck halfway and not be able to finish it. Or they'll send you the wrong stuff. You end up wasting hours chasing people down over email. 

That's why you should give Content Snare a try. 

Content Snare is packed with advanced features that will have you hours:

  • Automatic reminders - Remind people to complete their form with fully customizable reminders.
  • Reject incorrect information - If a single question is filled out incorrectly, ask your client to re-do just that one item.
  • Autosaving - No progress gets lost. People can fill out forms in multiple sittings.
  • Comments and questions - If the person filling the form gets stuck, they can ask a question without having to email you.

Give it a go by signing up for your free 14-day trial

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