Wellness Survey
With Base Theme

"Wellness Survey Form"

Turn Insights into Action with Wizara’s Smart Forms
Wellness Survey Form Template

Unlock the potential of personalized health insights with our detailed Wellness Survey Form. Designed for ease and confidentiality, this form offers a comprehensive assessment of individual health habits, dietary patterns, exercise frequency, smoking and drinking habits, as well as personal wellness goals.

The form is structured to capture vital information that can help healthcare providers, fitness coaches, or wellness programs tailor their services to the unique needs of each individual. It's an invaluable tool for collecting nuanced data that supports better understanding and improves health and wellness strategies.

With its straightforward design and customizable fields, the Wellness Survey Form is suited for health clinics, gyms, wellness blogs, or any platform focused on promoting healthy living. It's also optimized for all devices, ensuring that users can provide their information comfortably from anywhere, at any time.

Use this form to elevate the way you interact with clients, gather essential health data, and help others on their journey to personal wellness.

Wellness Survey Features

Personalized Health Insights
Personalized Health Insights
Unlock tailored health recommendations based on individual habits and goals.
Comprehensive Data Collection
Comprehensive Data Collection
Gather detailed information to enhance wellness strategies and support better understanding.
User-Friendly Design
User-Friendly Design
Easy-to-use form optimized for all devices, ensuring comfortable data submission.
Customizable Fields
Customizable Fields
Adapt the form to fit the unique needs of health clinics, gyms, or wellness programs.
Confidentiality Assurance
Confidentiality Assurance
Securely collect sensitive health information with a focus on user privacy.
Elevate Client Interaction
Elevate Client Interaction
Enhance client engagement by gathering essential health data for personalized services.
Wellness Survey Form Template
Customizable Form Fields
You can add, remove or re-arrange form fields when using our form builder app.
title (html-block)
name* (text, input)
Full Name
email* (email)
Email Address
exerciseFrequency* (select, dropdown)
How often do you exercise?
dietType* (select, dropdown)
What type of diet do you follow?
smoke* (boolean, buttons)
Do you smoke?
drink* (boolean, buttons)
Do you drink alcohol?
healthGoals* (text, textarea)
What are your health and wellness goals?

Try Out the Form for Yourself!

Experience Ease and Flexibility Across Multiple Devices and Screens

The form below is using our "Base" form theme. You can change the colors and the theme using the Wizara Form Builder app.