CLIENT INTAKE FORM
Welcome to The Way to Wellness. This intake helps Jenny understand your goals, health history, and preferences so your support can be personalized from day one.
Please complete this form before your first session. If you’re unsure about any question, it’s okay to leave it blank and we’ll review it together.
What to expect
- Takes about 8–12 minutes to complete.
- Your information is kept confidential and used only to support your wellness plan.
- If you have urgent medical concerns, please contact your healthcare provider or emergency services.
YOUR COACH:
Jenny Israel
The Way to Wellness
The Way to Wellness
Need help completing this?
If you’d rather share details verbally, you can submit what you can and we’ll fill in the rest together during your session.
Email: jenny@jennyisrael.com | Phone: 6314952276
Client Intake Details
Please answer as thoroughly as you feel comfortable. The more context you share, the more tailored your plan can be.
Sections included
- Contact information & preferred communication
- Primary goals and what success looks like
- Health history, medications, and current care team
- Lifestyle: sleep, stress, movement, nutrition, and support
- Consent, confidentiality, and coaching agreement
Complete the Intake Form
When you’re ready, fill out the form below and click submit. Jenny will review your responses before your first appointment.
Privacy note
Your information is used to support your wellness coaching experience. Please avoid sharing highly sensitive details you don’t want stored electronically. If you prefer, you can share certain information during your session instead.