Wellness Assessment

Wellness Assessment

When to Use This Skill

Use this skill when you need to:

• Create a wellness intake assessment for new coaching or training clients
• Build health history questionnaires that inform program design
• Design goal-setting frameworks for wellness engagements
• Evaluate lifestyle factors that affect client outcomes

DO NOT use this skill for medical intake forms, clinical assessments, or diagnostic questionnaires. This is for wellness coaches, personal trainers, and health coaches operating within their scope of practice.

Core Principle

A WELLNESS ASSESSMENT IS NOT A MEDICAL EXAM — IT IS A TOOL TO UNDERSTAND WHERE YOUR CLIENT IS, WHERE THEY WANT TO GO, AND WHAT LIFESTYLE FACTORS WILL HELP OR HINDER THEIR PROGRESS.

Phase 1: Assessment Scope

Required Inputs

GATE: Confirm scope of practice before designing the assessment. Only include sections you are qualified to evaluate.

Phase 2: Assessment Sections

Section 1: Personal Information

## Client Information

Name: _______________
Date: _______________
Date of birth: _______________
Email: _______________
Phone: _______________
Emergency contact: _______________
Emergency phone: _______________

Section 2: Health History

## Health History

**Current medical conditions (check all that apply):**
[ ] Heart disease or cardiovascular condition
[ ] High blood pressure
[ ] Diabetes (Type 1 / Type 2)
[ ] Asthma or respiratory condition
[ ] Joint or bone issues (arthritis, osteoporosis)
[ ] Back pain or spinal conditions
[ ] Thyroid condition
[ ] Anxiety or depression
[ ] Autoimmune condition
[ ] None of the above
[ ] Other: _______________

**Current medications:**
_______________

**Allergies (food, medication, environmental):**
_______________

**Past surgeries or injuries:**
_______________

**Are you currently under a doctor's care for any condition?** Yes / No
If yes, has your doctor cleared you for [exercise / dietary changes]? Yes / No / Not yet

**For women: Are you pregnant or planning to become pregnant?** Yes / No / N/A

**Do you have any physical limitations that affect movement or exercise?**
_______________

Section 3: Lifestyle Evaluation

## Current Lifestyle

**Sleep:**
- Average hours per night: ___
- Sleep quality (1-5, 5 = excellent): ___
- Do you have trouble falling or staying asleep? Yes / No

**Stress:**
- Current stress level (1-10, 10 = extremely stressed): ___
- Top 3 sources of stress: _______________
- How do you currently manage stress? _______________

**Nutrition (typical day):**
- Breakfast: _______________
- Lunch: _______________
- Dinner: _______________
- Snacks: _______________
- Water intake (glasses per day): ___
- Alcohol (drinks per week): ___
- Caffeine (cups per day): ___

**Physical Activity:**
- Current exercise frequency: ___ days/week
- Types of exercise: _______________
- Activity level at work: Sedentary / Lightly active / Active / Very active

**Habits:**
- Do you smoke? Yes / No / Former
- Screen time (hours per day outside of work): ___

Section 4: Goals & Motivation

## Your Goals

**Primary goal:**
_______________

**Why is this goal important to you right now?**
_______________

**What have you tried before to achieve this goal?**
_______________

**What worked? What didn't?**
_______________

**On a scale of 1-10, how ready are you to make changes?** ___

**On a scale of 1-10, how confident are you that you can succeed?** ___

**What is the biggest obstacle you anticipate?**
_______________

**How will you know you have succeeded? What does success look and feel like?**
_______________

**Timeline: When do you want to achieve this goal?**
_______________

Phase 3: Evaluation & Summary

Assessment Summary Template

## Wellness Assessment Summary — [Client Name]

**Date:** [Date]
**Assessed by:** [Your name]

### Key Findings

**Health considerations:**
- [Any conditions or medications that affect programming]
- [Referral needed? Yes/No — to whom]

**Lifestyle strengths:**
- [What they are already doing well]

**Lifestyle areas for improvement:**
- [Sleep, stress, nutrition, or activity gaps]

**Goal alignment:**
- Primary goal: [Goal]
- Readiness level: [X/10]
- Confidence level: [X/10]
- Timeline: [Stated timeline — realistic? Yes/No]

### Recommended Focus Areas (Priority Order)

1. [Focus area 1] — [Why and initial action step]
2. [Focus area 2] — [Why and initial action step]
3. [Focus area 3] — [Why and initial action step]

### Referrals Needed
- [ ] Medical clearance from physician
- [ ] Registered dietitian for [specific concern]
- [ ] Mental health professional for [specific concern]
- [ ] Physical therapist for [specific concern]
- [X] None needed at this time

Reassessment Plan

Schedule reassessments at regular intervals:

• 4-week check-in: Quick progress review, habit adherence, adjust as needed
• 8-12 week reassessment: Full assessment comparison, measure progress toward goals
• Ongoing: Brief monthly check-ins between full assessments

Phase 4: Implementation

Delivery Options

Assessment Checklist

• All sections are appropriate for your scope of practice
• Health history section covers conditions relevant to your service
• Consent and disclaimer are included (see health-disclaimer skill)
• Referral triggers are identified (when to refer to a medical professional)
• Assessment is stored securely and confidentially
• Reassessment schedule is communicated to the client
• Summary is reviewed with the client, not just filed away

Anti-Patterns

• Asking medical questions beyond your scope — if you are not a doctor, do not diagnose. Collect history and refer when appropriate.
• Collecting data and never using it — every question should inform your programming. Remove questions that do not change what you do.
• Skipping the health history — starting a fitness or nutrition program without knowing medical conditions is reckless.
• Not following up on red flags — if a client reports chest pain during exercise or an unmanaged condition, refer them to a physician before continuing.
• One assessment and done — progress tracking requires reassessment. Build it into your process.

Recovery

• Client does not disclose a condition: Include a clause that the client is responsible for disclosing all relevant health information and updating you if their status changes.
• Red flag in health history: Pause programming and require medical clearance. Do not design programs around conditions you are not qualified to manage.
• Client is resistant to the assessment: Explain that the assessment ensures their safety and helps you design the most effective program for them.
• Assessment is too long: Trim to essential sections only. A 30-minute assessment that gets completed beats a 60-minute one that gets abandoned.
• Client goals are unrealistic: Have an honest conversation. Adjust the timeline or reframe the goal to be achievable and measurable.