Client Intake Form

Help us understand your health history and goals so we can provide the best possible coaching experience.

Takes about 10 minutes 4 sections Confidential & secure
Personal Health Goals Consent
✓

You're all set.

Your intake form has been received. A member of the Ironwood team will be in touch within 1–2 business days to schedule your first session.

Book a Discovery Call Back to Home
Step 1 of 4

Personal Information

Basic contact details and military/veteran status.

Please enter your full name.
Please enter your date of birth.
Please enter your phone number.
Please enter a valid email address.
Emergency Contact
Military & Veteran Status
Step 2 of 4

Health Background

This information helps your coach prepare a safe, effective program. All health data is confidential.

Sharing this helps us coordinate care if needed.
Step 3 of 4

Coaching Goals

Tell us where you want to go. The more specific you are, the better we can tailor your program.

Please describe your primary goal.
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Step 4 of 4

Consent & Signature

Please read and acknowledge the following before signing.

Coaching is not medical care. I understand that health coaching provided by Ironwood Integrative Health is a supportive and educational service, not medical advice, diagnosis, or treatment. I will consult my physician or licensed healthcare provider for any medical concerns, and I will not delay seeking medical attention based on coaching conversations. My coach is not a licensed medical professional and will not diagnose conditions or prescribe treatments.
You must acknowledge this statement to continue.
Data storage and privacy. I authorize Ironwood Integrative Health to store the personal and health information I provide in this form securely for the purpose of delivering coaching services. My data will not be sold or shared with third parties without my explicit consent. I may request deletion of my data at any time by contacting the practice directly.
You must authorize data storage to continue.
By typing your name above you are electronically signing this intake form. This signature has the same legal validity as a handwritten signature.
Please type your full name as a digital signature.