This chronic pain coaching intake form is designed for coaches who need a clear picture of a client's condition before beginning support. It captures essential contact details along with background information such as diagnosis, length of time living with pain, pain location, average pain level, and how symptoms tend to show up throughout the day.
The questions go beyond basic intake by exploring how pain feels, what tends to make it worse, and how it affects daily life. That gives coaches better context for understanding each person's experience, identifying common triggers, and preparing for more focused, practical conversations during early sessions.
Because the form is structured, it also helps create a more consistent intake process across clients. You can review responses faster, spot patterns more easily, and use the information to shape coaching plans, session priorities, and quality-of-life goals with greater confidence.
