Enroll participants with the context to actually help them — goals, format, and experience level.
Healthcare template · 10 fields (5 required) · ~2 min for respondents to complete · Free plan · No credit card · Fully customizable
About this form
Wellness program enrollment is a matching problem: the registrant has goals, a preferred format, an experience level, and possibly accommodations to request — and your program has tracks, schedules, and capacity. This form collects the participant side of that match up front, so placement is deliberate instead of first-come-first-served.
For corporate wellness, the optional organization field lets one form serve both employer-sponsored cohorts and individual signups, with submissions routable by company.
Best practices
Health-goals answers are your program design feedback loop — if half your registrants write "stress," your class mix should reflect it.
Honor format preferences (in-person, virtual, hybrid, self-paced) in placement; format mismatch is the top cause of wellness program dropout.
Follow up on accommodation requests personally before the program starts — a templated "noted!" email reads as ignored.
Ask about previous experience so beginners are not placed alongside veterans on day one; it is the quiet driver of early attrition.
Every field, explained
Participant Name (Name, required)
Email Address (Email, required)
Phone Number (Phone, required)
Organization/Company (Short text)
Program Interest (Multiple choice) — Multi-select across your offerings — most registrants want more than one track, which shapes scheduling.
Program Duration Preference (Dropdown, required)
Preferred Format (Multiple choice) — The dropout-prevention field. Place people in the format they chose.
Previous Wellness Program Experience (Single choice, required)
Health Goals and Expectations (Long text) — Free text on purpose: the aggregate answers are the best program-design data you will collect.
Special Accommodations Needed (Long text) — Requests here need a human reply before day one, not an autoresponder.
Frequently asked questions
What should a wellness program registration form ask?
Contact details, the programs of interest, preferred format and duration, previous experience, health goals, and any accommodations needed. This template collects all of it in ten questions — long enough to place people well, short enough that they finish it.
Is this the same as a wellness assessment questionnaire?
No — this form handles enrollment. A wellness assessment (health metrics, lifestyle screeners) is a deeper instrument, usually sent after registration. Many programs use this form first, then send their assessment to enrolled participants.
Can I use this form for a corporate employee wellness program?
Yes — the organization field routes employer-sponsored registrations by company. For a closed program, share the link internally; submissions can trigger notifications to your program coordinator.
Related healthcare templates
Patient Intake Form — Comprehensive patient information and medical history form