Couples Therapy Intake Form Template
This form gathers both partners’ contact details, relationship concerns, therapy goals, counseling history, and availability for a couples therapist.
When to use it
- Before a couple’s first therapy appointment
- When a new couple contacts your practice
- To learn both partners’ goals before a session
- When scheduling an initial consultation
What it asks
- Your name
- Your email address
- Your phone number
- Your partner’s name
- How long have you been together?
- What are the main concerns bringing you to therapy?
- What would you like to work toward in therapy?
- Have either of you attended counseling before?
- Is there anything about previous counseling you’d like us to know?
- When are you generally available?
Why it should be encrypted
Relationship concerns, counseling history, and contact details are personal. They should be accessible only to the partners and the intended therapist or authorized practice staff—not SealForm or unintended readers.
Tips
- Tell both partners who will review their answers and when.
- Add a question about whether either partner has accessibility or communication needs.
- Let partners know they can discuss anything they prefer not to share on the form in person.