Couples & Family Therapy Intake Form Template

An individual therapy intake asks one person about themselves. This one is built for two or more people in the room: who is attending and how they are related, who filled the form in, whether everyone actually wants to come, how long the difficulty has been going on, and goals recorded separately in each person's own words rather than merged into one account. It closes with a plainly explained contact-boundaries section — whether a voicemail is safe, which number to use, and whether anyone should not be contacted.

Use this template

Last updated 21 August 2026

Fields in this template

Who Is Completing This Form?required
One of the adults who will be attending · A parent or guardian, for the family · The person who made the booking, for everyone attending · Someone else supporting the family
Your Namerequired
Your Email Addressrequired
Your Phone Number
Who Will Be Attending, and How Is Each Person Related to the Others?required
How Many People Will Be at the First Session?
Does Everyone Attending Know About This Appointment and Want to Come?required
Yes — everyone has agreed · Mostly, but one person is unsure · No — I am booking before I have spoken to them · I would rather talk about this in the session
What Brings You to Therapy Now?required
How Long Has This Been Going On?required
Less than a month · 1 to 6 months · 6 to 12 months · 1 to 3 years · More than 3 years · It comes and goes · I'm not sure
Why Now? Has Something Changed Recently?
Which of These Would You Like to Work On?
Communication · Conflict and arguments · Trust after a betrayal · Parenting differences · Deciding whether to separate · Separating or divorcing well · Co-parenting after a separation · Step-parenting or a blended family · Intimacy and closeness · Money and financial stress · Illness, disability or caring responsibilities · Grief or bereavement · A family member's mental health · Alcohol or drug use · Cultural, faith or identity differences · Something not listed here
Your Goal for Therapyrequired
The Other Adult's Goal, in Their Own Words
Any Other Participant's Goal
Is There Anything You Disagree About Regarding Coming to Therapy?
Have You Been to Therapy Together Before?required
Yes — we are seeing someone now · Yes — in the past, but not now · No, but one of us has had individual therapy · No — this is the first time · I don't know
What Was Helpful or Unhelpful About It?
Is Anyone Attending Currently Working With Another Professional?
An individual therapist or counsellor · A psychiatrist or a doctor, for mental health · A social worker or a family support service · A mediator · A solicitor or lawyer, about a separation · A school counsellor or pastoral lead · No one else is involved · Prefer not to say
Anything About Health, Medication or Neurodivergence We Should Know
Is It Safe to Leave a Voicemail or a Text on Your Number?required
Yes — either is fine · Voicemail only · Text only · Call, but please don't say what it is about · No — please don't leave any message
Best Number to Reach You On
Is It Safe to Email You at the Address Above?
Yes · Yes, but please keep the subject line neutral · No — please use the phone instead · No — I will give you a different address at the session
Is There Anyone Who Should Not Be Contacted, or Not Told About These Appointments?
Anything Else You Would Like Your Therapist to Know Before the First Session?
Before You Submitrequired
I understand this form helps my therapist prepare for a first session, that it is not an assessment or a diagnosis, and that anything urgent should go to an emergency or crisis service rather than to this form.

Who uses this template

Couples counsellors and marriage therapistsMarriage and family therapists (LMFTs)Family therapy and systemic practice teamsPrivate practice therapists offering relationship workCommunity and low-cost counselling servicesEmployee Assistance Programmes offering relationship counsellingFaith-based and pastoral counselling servicesSeparation, co-parenting and mediation support services

About this template

Couples and family therapy intake is a different job from individual intake, and the difference starts at the first field. An individual form has one client name, one email and one phone number. A couples or family form has to record who is attending, how each person is related to the others, who filled the form in, and whether everyone in that list actually agreed to come. This template asks all four, because a therapist who learns in the room that one partner did not know about the appointment is starting the work at a disadvantage that a form could have prevented.

Goals are recorded separately rather than merged. The person completing the form writes their own goal, then has space for the other adult's goal in that person's own words, and space again for a third or fourth participant — a co-parent, a teenager, a grandparent. The field descriptions say plainly that answering on someone else's behalf is worth less than asking them, and that a family who would rather answer privately should ask the therapist for an individual copy of the form link, because one submission is one shared answer sheet.

The last section is about contact, not about the relationship. Appointments are private, and a voicemail on a shared phone or a reminder email read by the wrong person can cause real trouble at home. The form asks whether a voicemail or a text is safe, whether there is a better number, whether email is safe, and whether anyone should not be contacted at all — with a paragraph above it explaining exactly why it is being asked and permission to leave any of it blank. It is a boundaries question, not a risk assessment: this form does not screen for abuse, does not score anything, and is not a substitute for the individual safety screening that many services carry out with each adult separately before joint work begins. formformform hosts every form in the EU under GDPR, and optional end-to-end encryption can be switched on per form before the first response arrives.

14 form ideas you can build with this template

Couples Counselling First-Session Intake

Record both partners, how long the difficulty has lasted, and each person's goal in their own words before session one.

Marriage Counselling Intake Form

Collect relationship length, what changed recently, and whether both spouses have agreed to attend.

Pre-Marital Counselling Intake

Use the topic checklist and separate goal fields to surface where a couple already knows they disagree.

Family Therapy Intake (Parent-Completed)

Let a parent list everyone attending with ages and relationships, and leave space for a young person's own goal.

Blended Family Therapy Intake

Capture step-parenting and household arrangements in the participants field, where a single client-name box would lose them.

Co-Parenting After Separation Intake

Record two separated adults, their separate goals, and whether it is safe to leave messages on either number.

Discernment Counselling Intake

Use the 'deciding whether to separate' topic and the disagreement field for couples who are not yet agreed on the work itself.

Parent and Adolescent Therapy Intake

Collect the parent's account and the young person's goal separately rather than merging them into one narrative.

Online Couples Therapy Intake Form

Gather participants, goals and contact boundaries before a first video session, alongside a telehealth consent form.

Faith-Based Marriage Counselling Intake

Use the cultural, faith and identity topic option and the free-text goals for pastoral counselling services.

Relationship and Intimacy Therapy Intake

Record the presenting concern and each partner's goal with a topic list that names intimacy explicitly rather than implying it.

Bereavement Family Support Intake

Use the participants field for a whole household and the 'why now' field to record the loss that prompted contact.

EAP Relationship Counselling Intake

Collect the same joint history for an employer-funded programme, with contact boundaries that keep sessions private from a shared home phone.

Community Family Services Intake

Record which other professionals are already involved so a low-cost service can join up with social care or school support.

What's included

A participants field that records who is attending and how each person is related, instead of one client-name box

A required question about who completed the form, so the therapist knows whose voice they are reading

An explicit question about whether everyone attending has agreed to come, with a 'rather discuss it in the session' option

Three separate goal fields so each participant's goal is recorded in their own words rather than summarised by one person

A contact-boundaries section covering voicemail, a safer number, email, and anyone who should not be contacted

A plain-language explanation above that section of why it is asked, and permission to leave it blank

Previous joint therapy asked separately from previous individual therapy — they are different histories

A checklist of other professionals already involved, so care can be joined up with consent

An emergency and crisis instruction at the top of the form rather than in the small print

How to create a couples & family therapy intake form

1
Click "Use this template" to load the couples and family therapy intake form into your free formformform account.
2
Decide whether you want one shared submission or one per participant. For one per participant, send each adult their own copy of the link and delete the two extra goal fields from that version.
3
Edit the contact-boundaries paragraph so it names what your service actually does — who calls, from which number, and what a reminder message says.
4
Check the topic checklist against the work you take. Remove anything you do not offer rather than leaving a family to tick it and be turned away later.
5
Add your own individual safety screening as a separate step. This form is not one, and joint intake is the wrong place to ask about it.
6
Turn on end-to-end encryption for the form in your account settings before you publish, so answers are sealed to your key before they are stored.
7
Add conditional logic in the editor if you want the family-specific questions to appear only for family bookings — templates cannot ship branching, so it is added after cloning.
8
Publish and send the link with the appointment confirmation, addressed to whoever booked.

Best practices for your couples & family therapy intake form

Ask who is answering. In joint work the identity of the author changes how everything else on the form reads, which is why that question is required and comes before the content.

Record goals separately, and say why. Two people rarely want the same thing from therapy, and a merged goal hides the disagreement the work will be about.

Send individual copies when private answers matter. One submission is one shared answer sheet. If each adult needs to answer without the other reading it, send each of them their own link rather than trying to make one form do both jobs.

Explain the contact questions before you ask them. An unexplained question about who may be contacted reads as suspicion. One short paragraph naming the actual reason

voicemails, reminders, a shared phone — is the difference between an answered question and a blank one.

Do not turn the contact section into an abuse screen. Screening for safety needs individual conversations with each adult, not a shared form filled in at the kitchen table. Keep this section to boundaries, and run your screening separately.

Keep the whole safety and contact section optional except the voicemail question. Someone who cannot safely answer must still be able to submit and get an appointment.

Ask about other professionals already involved. Family work sits alongside mediation, social care, school pastoral teams and solicitors more often than individual work does, and knowing avoids working against someone else's plan.

Include children's own words where they are attending. A goal written by a parent on behalf of a fourteen-year-old is a parent's goal.

Turn on end-to-end encryption before the first submission. It is opt-in per form and freezes once the first response arrives.

Do not describe the form as an assessment, and do not claim compliance. EU hosting and GDPR handling are real and can be said. SOC 2 and ISO 27001 belong to the hosting provider, and no form makes a practice HIPAA compliant.

Frequently asked questions

Is this couples and family therapy intake form free?

Yes. Use it, customise it and collect unlimited submissions at no cost, with no per-submission fees.

How is this different from the therapy intake form?

The therapy intake form is built for one client: one name, one email, one set of goals. This one records who is attending and how they are related, who completed the form, whether everyone agreed to come, and each participant's goal separately — plus a contact-boundaries section that an individual intake has no reason to carry.

Should each partner fill in their own copy?

That is often better, and it is a two-minute change: send each adult their own copy of the form link and delete the extra goal fields from that version. One shared submission is one shared answer sheet, so anything written on it is read as coming from the group.

Why does the form ask whether it is safe to leave a message?

Because appointments are private and a voicemail on a shared phone, or a reminder read by someone else, can cause real problems at home. The form explains that in plain words before it asks, and every part of the section can be left blank.

Is this a safety or domestic abuse screening tool?

No, and it should not be used as one. Safety screening needs an individual conversation with each adult, held privately, by a clinician. This form records contact boundaries only. Many services screen each adult separately before starting joint work — keep that step, and keep it off this form.

Can children or teenagers complete part of it?

Yes. The third goal field exists for exactly that, and its description says a young person's own words are worth more than a summary of them. Whether a young person completes it themselves is a clinical judgement for your service.

How is this information protected?

Every form is hosted in the EU, with TLS in transit and AES-256 encryption at rest, and submissions are handled under GDPR. You can also switch on end-to-end encryption for your own copy, which seals each answer in the client's browser to your public key before it is stored. It is opt-in per form and freezes once the first response arrives.

Can I add a consent-to-treatment section?

Yes. Add a paragraph field with your own consent wording and a required checkbox beneath it. For joint work, remember that each adult consents for themselves — a single tick on a shared form is one person's tick.