Wellness Intake Form Template for England and Wales

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Key Requirements PROMPT example:

Wellness Intake Form

"I need a Wellness Intake Form for my new holistic health clinic opening in March 2025, focusing on collecting detailed medical history and lifestyle information while ensuring compliance with UK GDPR requirements for a small practice with fewer than 50 clients."

What is a Wellness Intake Form?

The Wellness Intake Form is a crucial document used across various wellness and healthcare settings in England and Wales. It serves as the initial point of contact between service providers and clients, collecting vital information necessary for safe and effective service delivery. The form is designed to comply with UK GDPR and healthcare regulations while gathering comprehensive data about a client's health status, medical history, and lifestyle factors. This intake form helps practitioners assess client needs, identify potential contraindications, and maintain accurate records for both medical and legal purposes. It typically includes both mandatory and optional sections depending on the specific services being offered.

What sections should be included in a Wellness Intake Form?

1. Personal Information: Basic contact details, emergency contacts, date of birth, and identification information

2. Medical History: Current and past health conditions, medications, allergies, surgeries, and treatments

3. Lifestyle Information: Exercise habits, diet, sleep patterns, stress levels, occupation, and daily activities

4. Privacy Notice: GDPR-compliant information about how personal data will be collected, processed, stored and protected

5. Consent Declaration: Client's explicit agreement to information sharing, treatment, and acknowledgment of privacy terms

What sections are optional to include in a Wellness Intake Form?

1. Family Medical History: Optional section for collecting information about genetic conditions and family health patterns when relevant to treatment

2. Mental Health Assessment: Optional section for evaluating mental health status, stress levels, and emotional well-being when offering related services

3. Dietary Preferences: Optional section for detailed nutritional information and dietary restrictions when nutrition services are included

4. Physical Activity Readiness: Optional section for assessing fitness levels and exercise capability when physical activities are part of the wellness program

What schedules should be included in a Wellness Intake Form?

1. Terms and Conditions: Detailed service terms, cancellation policies, liability provisions, and legal disclaimers

2. Privacy Policy: Comprehensive data protection procedures, confidentiality measures, and information handling protocols

3. Medical Release Authorization: Standard form for authorizing the release of medical records from other healthcare providers if needed

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

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Find the exact document you need

Medical Intake Form

A standardized template for collecting patient information in England and Wales, compliant with UK healthcare and data protection regulations.

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Let's create your Wellness Intake Form

What is a Wellness Intake Form?

What sections should be included in a Wellness Intake Form?

What sections are optional to include in a Wellness Intake Form?

What schedules should be included in a Wellness Intake Form?

Authors

Alex Denne

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