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Health Coach Intake Form Template
I need a Health Coach Intake Form Template that complies with UK GDPR and includes comprehensive sections for nutritional assessment and mental health screening, as I'm launching a holistic wellness coaching practice in March 2025 focusing on both physical and emotional wellbeing.
1. Personal Information: Basic contact details, emergency contacts, and demographic information required for client identification and communication
2. Medical History: Current and past health conditions, medications, treatments, surgeries, and allergies
3. Lifestyle Assessment: Comprehensive overview of diet, exercise, sleep patterns, stress management, and daily habits
4. Goals and Expectations: Client's specific health and wellness objectives, timeframes, and desired outcomes
5. Privacy Notice: GDPR-compliant data protection and confidentiality statements, including how personal information will be used and stored
1. Nutritional Assessment: Detailed dietary preferences, restrictions, supplements, and eating patterns for nutrition-focused coaching
2. Physical Activity History: Comprehensive exercise history, fitness level assessment, and physical activity preferences for fitness-focused coaching
3. Mental Health Assessment: Evaluation of stress levels, anxiety, depression, and other mental health factors for holistic wellness coaching
1. Terms and Conditions: Detailed service terms, cancellation policies, liability limitations, and legal disclaimers
2. Consent Forms: Medical information sharing authorization and coaching program participation consent documents
3. Health Metrics Tracking Sheet: Standardized template for monitoring progress and key health indicators throughout the coaching program
Authors
Client
Coaching Services
Confidential Information
Data Protection Laws
Emergency Contact
Health Information
Intake Form
Medical History
Personal Data
Privacy Notice
Professional Services
Service Provider
Sensitive Personal Data
Terms and Conditions
Wellness Goals
Lifestyle Information
Health Assessment
Consent
Medical Conditions
Treatment Plan
Progress Tracking
Healthcare Provider
Dietary Requirements
Exercise History
Medical History Disclosure
Confidentiality
Data Protection
Consent
Information Sharing
Emergency Contacts
Liability Limitations
Health Disclaimers
Privacy Notice
Medical Release
Record Keeping
Information Updates
Client Rights
Professional Boundaries
Communication Preferences
Goals and Objectives
Service Scope
Health and Safety
Dietary Restrictions
Exercise Limitations
Medical Referrals
Progress Monitoring
Termination Rights
Documentation Storage
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