Coaching and Certificate Program Forms

Healthie has partnerships with many coaching academies, graduate schools, and accreditation services, whose graduates use the platform to run their businesses and build relationships with clients. As part of these affiliations, Healthie makes it easy for you to access recommended forms from these coaching programs, which allows clients to fill out these forms online. Moreover, for your convenience, these forms are available pre-loaded into your account, so you are not needing to create these forms from scratch. 

If you'd like to request that forms be added to your account, please e-mail hello@gethealthie.com; proof of your affiliation with a specific group may be requested. These coaching-specific forms are available in addition to Healthie's default template library available in all accounts. 

If you a part of a program, but do not see your program listed, please message us, as this directory is ever-evolving. 

The FM Shift

• Functional Medicine Intake
• Office Policies 
• HIPAA
• Telehealth Informed Consent 
• Group Telehealth Informed Consent
• Advance Beneficiary Form
• Covid-19 Screening Form
• Cancellation Letter
• Diabetes Application Intake
• Hypothyroid Application Intake
• Cognitive Decline Application Intake
• Functional Medicine SOAP
• Getting Familiar with your Saliva Test Kit
• Recommended Action Plan-CD 19
• Recommended Action Plan DB
• Recommended Action Plan CD24
• ICHR Informed Consent
• Recommended Action Plan 16 (RAP DB16)
• Recommended Action Plan 16-2
• Recommended Action Plan 16-3
• Recommended Action Plan 16-4
• Recommended Action Plan 16-5
• Recommended Action Plan 16-6
• Recommended Action Plan 16-7
• Recommended Action Plan DB/INS
• Recommended Action Plan E Dalrymple
• Recommended Action Plan TH-19
• Recommended Action Plan TH-19-2
• Recommended Action Plan TH-19-3
• Recommended Action Plan TH-19-4
• Recommended Action Plan TH-19-5
• Recommended Action Plan TH-19-6
• Recommended Action Plan TH-19-7
• Recommended Action Plan TH-19-8
• Recommended Action Plan TH-19-9
• Recommended Action Plan 12
• Recommended Action Plan 12-2
• Recommended Action Plan 12-3
• RAP Diabetes 12

Functional Medicine Fast Track (FMFT)

• Functional Medicine Timeline
• Sleep Questionnaire
• Food Reintroduction Symptom Tracker
• ADAM Questionnaire form Men          
• BPH Symptom Index 
• Daily Activity Questionnaire 
• Goal Setting for Behavior Change
• Practicing Gratitude    
• Self-Care Questionnaire                                    
• Toxin Exposure                                                
• Thyroid Screening Questionnaire            
• Depression Anxiety Stress Scales
• Male Intake Questionnaire                               
• 1 Day Diet, Nutrition, and Lifestyle Journal 
• 3 day Diet, Nutrition, and Lifestyle Journal       
• 7 Day Diet, Nutrition, and Lifestyle Journal
• Prescription and Lifestyle Plan                           
• Exercise History Questionnaire
• MSQ
• Male Intake Questionnaire 
• Female Intake Questionnaire 
• Male and Female Combined Intake Questionnaire 
• Physical Evaluation

Primal Health Coach Institute

• Check-in Form
• Daily Journal Form
• Discovery Form
• Evaluation Form
• Intake Form
• Post Coaching Session Form

Integrative and Functional Nutrition Academy (IFNA)

• IFNA Long Form 
• IFNA Short Form 
• IFNA Hands On 
• IFNA Dietary Assessment 
• IFNA MSQ
• IFNA Clinical Matrix Br
• IFNA MYSQL or Client Intake Form
• IFNA 3 Day Food Diary
• IFNA Patient Questionnaire
• Digestive History

Institute of Functional Medicine (IFM)

• IFM MSQ 
• IFM Female Intake 
• IFM Male Intake 
• IFM 3-day journal 
• IFM Self-care 
• IFM Thyroid 
• IFM Sleep 
• IFM Toxin Exposure 
• IFM Depression / Anxiety 
• IFM Exercise / Diet Nutrition 1 Day journal 
• IFM Practicing Gratitude  
• IFM Goal Setting for Behavior Change 
• IFM 1 day / 3 day / 7 day journal 
• IFM Daily Activity Questionnaire 

Functional Medicine Coaching Academy (FMCA)

• Food Symptom Diary
• MSQ (Medical Symptoms Questionnaire)
• PERMA (Positive, Emotion, Engagement, Relationships, Meaning, Accomplishment)
• PROMIS 10 (Patient-Reported Outcomes Measurement Information System)
• Environmental Exposure History Form
• Metabolic
• Life Stress
• Self Care Questionnaire
• FMP Stress Assessment

Functional Diagnostic Nutrition (FDN)

• Metabolic Chaos Scorecard 
• Client US FDN 90-Day Protocol
• Metabolic Charos Screcored Combined
• FDN Case Notes
• Client Europe FDN 90-Day Protocol
• Metabolic Typing Diet Check Record Sheet
• Client Terms of Service Agreement
• Lifestyle and Medical History 
• Adrenal Stress Indicators (ASI)
• Adrenal Stress Causes (ASC)
• Client Medical History Form

Better Nutrition Program

• Rainbow Evaluation Form
• Full assessment suite is available; e-mail team@thebetternutritionprogram.com for information

Institute for Integrative Nutrition (IIN) 

• Men's Health History 
• Women's Health History 
• Gender Neutral Health History
• Senior Health History
• Female Teen Health History
• Male Teen Health History
• Children History

Lifestyle Eating and Performance (LEAP)

• Initial Symptom Survey
• Follow up Symptom Survey
• Pre-Assessment and Follow Up
• Food Avoidance
• MRT Test Requisition
• Initial Patient Consult
• Patient Consultation Chart notes
• Initial Symptom Survey
• Follow up Symptom Survey
• Follow up Symptom Survey 2
• Follow up Symptom Survey 3
• Follow up Symptom Survey 4
• Standard Form
• Personalized Immunocalm Diet Program
• Menu Planner
• Food/Symptom Diary

Function Nutrition Alliance (FxNA)

• FxNA Intake Form
• FxNA Getting to know you
• Crohn’s Symptom Tracker (matrix)
• FxNA Yeast Questionnaire
• FxNA Supplement Tracker
• FxNA Lab Tracker 
• FxNA Sleep Assessment
• FxNA 5 Day Journal
• Timeline Clinical ID
• Action Form
• Matrix Form

American Council on Exercise (ACE)  

• Lifestyle Questionnaire
• Food Log 
• Activity Log 
• Setting SMART Goals 
• Lapse Self-Monitoring Worksheet 
• My Successes Contract 
• Decisional Balance Worksheet - 
• Exercise History and Attitude Questionnaire - 
• PAR Q AND YOU 
• Behavioral Contract 
• Food Diary/Record 
• Food Frequency Questionnaire 
• Lifestyle Questionnaire v2 
• Lifestyle and Health Questionnaire 
• Lifestyle and Health History Questionnaire 
• Musculoskeletal Health Questionnaire
• Weight Loss Readiness Quiz 
• Readiness to Change Questionnaire 
• My Hunger Scale 
• High-Risk Solutions Worksheet 
• Taking the Big View 
• Body-Composition Assessment Results 
• Decisional Balance Worksheet 
• Physical-Fitness Assessment Results 
• Sample Medical Release Form 
• Calories in your Drink 
• Whoa! And hold up! 
• We Can! Go, Slow, and Whoa Foods 
• My Rewards 
• Healthy Choices When Eating Out 
• Grocery List 
• A Personal Transformation Worksheet 
• Comparing Meals: Actual, Planned, & Ideal 
• Weekly Meal Planner 
• Build A Healthy Meal 
• Goal Check In 1
• Barriers WorkSheet 
• Decisional Balance Worksheet 
• Physical-Fitness Assessment Results
• Sample Medical Release Form

National Academy of Sports Nutrition (NASM)

• Readiness For Exercise
• Cardio Assessment
• Body Composition
• Static Posture Assessment
• Dynamic Posture Assessment
• Strength Assessment
• Daily Opt Programming
• Annual- Monthly- Weekly Opt Programming

National Strength and Conditioning Association (NSCA)

• Client Readiness for Exercise
• Strength Assessment
• Static Postural Assessment
• Dynamic Postural Assessment
• Daily OPT Programming
• Cardiorespiratory Assessment
• Body Composition
• Annual & Monthly/Weekly OPT Programming
• NASM CPT Par Q

Diabetes Self Management Education (DSME) 

• Educational Action Plan
• Communication to Provider
• Follow up- Assessment
• Smart Goals
• Patient Self-Questionnaire 
• Clinical Data Outcome

Maryland University of Integrative Health (MUIH) 

• MSQ
• ABN- Medicare R. Galicinao
• Readiness Assessment
• Medsappriv Contract
• Informed Consent for Functional Laboratory
• Finance Policy
• ABN Medicare
• Consent Selling Nutrition
• Intake
• Consent for Treatment
• Functional Medicine Practitioner
• Consent for OMM
• Informed Consent for E-mail Communication

Integrative Health and Wellness Assessment Tool (IHWA)

• Long form 
• Short form 

Precision Nutrition (PN)

• Sleep Assessment Worksheet
• Initial Assessment Triage
• Eating Habits Questionnaire