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Second Spring Health Coaching

Client Pre-Screening & Intake Form

Supporting women through pre-menopause and menopause with clarity, compassion, and evidence-based lifestyle care.

Menopause is a significant life transition, often accompanied by big physical, emotional, and lifestyle changes. At Second Spring, we view this stage not as an ending, but as an opportunity to re-orient health, energy, and wellbeing for the many years ahead.

Second Spring Health Coaching operates in accordance with the Health Coaches Australia and New Zealand Association (HCANZA) Scope of Practice and Code of Ethics. Coaching is delivered within professional scope, with a strong emphasis on lifestyle-based support, evidence-based information, and appropriate referral where medical care is indicated.

This form helps us gently explore your current experience and determine whether menopause-focused health coaching is the right next step for you. It can also help identify if additional medical support may be appropriate alongside, or instead of, coaching.

This is not a medical assessment. As a Certified Menopause Practitioner and Health Coach following HCANZA guidelines, Johanna Huntress does not diagnose or treat medical conditions.

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Your details

Section 1

Current experience of menopause

Which best describes your current experience?

Section 2

Current healthcare support

Are you currently under the care of a GP, specialist, or other healthcare provider?
Are you currently using any prescribed medications?
Are you currently on any type of hormone therapy?
Are you currently taking any vitamins, minerals, nutraceuticals or herbs?
How would you describe your health in general?

Section 3

Health history & referrals

Have you been advised to closely monitor your health, symptoms, or physical activity?
Have you been advised not to make changes to exercise, diet, or lifestyle without medical guidance?
Are you currently experiencing symptoms that you feel require urgent or specialist medical assessment?
Are you comfortable seeking medical advice or clearance if recommended?

Do you have a family history of any of these conditions?

Cardio-vascular disease
High Blood Pressure
Cancer
Diabetes
High Cholesterol
Blood Clots
Stroke

Section 4

Menopause-related experiences

Scale: 0 = Not at all | 1 = Mild | 2 = Moderate | 3 = Significant

Section 5

Emotional wellbeing check

Over the past month, have you noticed:

Feeling isolated, lonely or disconnected?
Feeling low, flat, or emotionally overwhelmed?
Loss of interest or pleasure in things you usually enjoy?
Ongoing worry or anxious thoughts affecting daily life?
Do you have support? A therapist, counselor, or other?

Section 6

Lifestyle foundations

Sleep quality
Nutrition patterns
Movement
Do you drink alcohol?
Do you smoke or vape?
Any other substances?

You can discuss this further in your calls.

Section 7

Growth

Menopause is often framed as a universal experience, but the reality can be very different. Studies have shown that a woman's culture, ethnicity, values, and environment can all shape how someone experiences menopause.

Section 8

Readiness for coaching

Please confirm:

Section 9

Your priorities