# Wellness Assessment Form Template

> A free wellness assessment for health coaches and holistic practitioners. Clients rate sleep, stress, energy, movement and more, and share their goals.

A whole person wellness questionnaire that covers sleep, energy, stress, movement, food, relationships, purpose, work and money. Use it at the start of a program and again later to see what changed.

Canonical: https://reuily.com/templates/wellness-assessment-form
Use this template: https://reuily.com/form/from-template/wellness-assessment-form
Collections: Feedback & Surveys, Requests & Intake, Coaching, Holistic Wellness
Last updated: 2026-10-24

## Questions

- Question 1: What's your full name? (Short Text, required)
- Question 2: What's your email address? (Email, required)
- Question 3: How many hours do you usually sleep? (Single Choice, required). Options: Less than 5; 5 to 6; 7 to 8; More than 8
- Question 4: How rested do you feel when you wake up? (Opinion Scale, required)
- Question 5: How would you rate your energy during the day? (Opinion Scale, required)
- Question 6: How stressed do you feel most days? (Opinion Scale, required)
- Question 7: How many days a week do you move for 30 minutes or more? (Single Choice, required). Options: 0; 1 to 2; 3 to 4; 5 or more
- Question 8: How well do you eat most days? (Opinion Scale, required)
- Question 9: How connected do you feel to friends and family? (Opinion Scale, required)
- Question 10: How much meaning or purpose do you feel in your life? (Opinion Scale, required)
- Question 11: How do you feel about your work? (Opinion Scale, required)
- Question 12: How secure do you feel about money? (Opinion Scale, required)
- Question 13: Which areas would you like help with? (Multiple Choice, required). Options: Sleep; Stress; Energy; Movement; Food; Relationships; Purpose; Work and life balance
- Question 14: What would feeling well look like for you in 3 months? (Long Text, required)

## Common uses

- Health and wellness coaches
- Holistic practitioners and wellness spas
- Programs measuring progress over time

## Key features

- Ten simple wellness scales
- Simple 1 to 5 scales
- Goals in the client's own words

## Frequently asked questions

### What does a wellness assessment cover?

Sleep, energy, stress, movement, food, relationships, purpose, work and money, based on the 8 dimensions of wellness, plus the areas the client wants help with.

### Who uses a wellness questionnaire?

Health and wellness coaches, holistic practitioners, wellness spas and retreat hosts who want a full picture of a client before they start working together.

### Can I track progress over time?

Yes. Send the same form at the start and end of a program, then compare each client's answers in Google Sheets.