Therapy Client Intake Form Template
A therapy client intake form for psychotherapists to collect contact details, reasons for seeking therapy, goals, prior therapy, medications, emergency contact information, and consent.
When to use it
- Before a client’s first therapy appointment
- When a new client is setting up care
- When gathering emergency contact details for intake
- When a client wants to share therapy goals before a session
What it asks
- What is your full name?
- What is your email address?
- What is your phone number?
- What brings you to therapy at this time?
- What would you like to work toward in therapy?
- Have you had therapy before? If so, what was helpful or unhelpful?
- Are you currently taking any medications?
- What is your emergency contact’s name?
- What is your emergency contact’s relationship to you?
- What is your emergency contact’s phone number?
- I consent to sharing the information in this form with my psychotherapist for therapy intake and care.
Why it should be encrypted
Responses may reveal mental health concerns, medication use, and personal contact details. They should be readable only by the client and the psychotherapist handling their care, not by SealForm or unrelated people.
Tips
- Explain how and when the psychotherapist will review the answers.
- Let clients know they can skip questions they are not ready to answer.
- Review emergency contact details with the client and confirm they are current.