Help new clients feel heard from the very first interaction. This therapy intake form invites clients to describe what brings them to therapy in their own words, identify current symptoms, share relevant history, and indicate their therapy type preference — giving therapists essential context before the first session even begins.
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A therapy intake form does double duty: it collects the clinical and administrative information a practice needs to prepare for a new client, and — if written well — it begins the therapeutic relationship with warmth rather than bureaucracy. The language and structure of the form send a message about what the therapy experience will feel like. This template prioritizes client-centered phrasing: 'What brings you to therapy at this time?' rather than 'Chief complaint.'
Clinically, the form covers the core elements any therapist needs before a first session: presenting concerns, current symptom picture, relevant personal and family history, prior therapy experience, and payment logistics. The symptom checklist is broad enough to surface issues the client might not have thought to mention explicitly, while the open-ended text field gives them space to describe their experience in their own words — often the most useful clinical data of all.
formformform is an ideal tool for therapy practices that want to professionalize their intake process without investing in expensive practice management software. You get a clean, mobile-friendly form, instant email notification when a client submits, and a searchable submission dashboard — all free. The form can be sent via a link in your scheduling confirmation email or embedded on your website's new client page.
Use your own copy to change labels, remove questions and add the details you need. Try the preview alongside this guide to see what respondents will be asked.
Review the starting questions and choices. You can change them in your own copy.
Jane Doe
you@email.com
(555) 123-4567
Name: Jane Smith | Phone: (555) 987-6543
Name of provider, person, or organization who referred you
Describe in your own words what is going on and what you are hoping to work on
Share any background you feel is relevant — family dynamics, significant life events, relationships, or other context
Suggested uses, and why this starting point can help. Adapt the questions to your own process.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Date of Birth” in particular and adapt it to the detail you need.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “How were you referred to us?” in particular and adapt it to the detail you need.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Referral Source (if applicable)” in particular and adapt it to the detail you need.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “What brings you to therapy at this time?” in particular and adapt it to the detail you need.
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Which of the following are you currently experiencing?” in particular and adapt it to the detail you need.
Asks about spiritual practices, religious background, and how faith intersects with the presenting concerns for pastoral or faith-integrated therapy.
Collects substance use history, prior treatment attempts, current stage of change, and co-occurring mental health conditions.
Gathers employer EAP authorization information alongside presenting concerns for short-term work-focused counseling.
Click "Use this template" to build on this foundation in the formformform editor.
Adjust the symptom checklist to reflect the areas your practice specializes in — add trauma-specific items for a PTSD specialty practice, or relationship-focused items for a couples therapy practice.
Add a consent or confidentiality notice paragraph so clients understand the limits of confidentiality before they share personal details.
Configure email notifications to alert your intake coordinator or directly to the assigned therapist.
Send the form link to new clients after they schedule their first appointment — give them at least 24 hours to complete it thoughtfully.
Publish the form link and share it as part of your new client welcome sequence or embed it on your website.
avoid clinical jargon in field labels. 'What brings you to therapy right now?' invites more honest answers than 'Chief complaint'.
new clients may not feel safe sharing trauma history on an online form. Make these optional and revisit them in session.
a short paragraph explaining that responses are private and covered by therapist-client privilege helps clients feel safe filling out the form honestly.
knowing if a client has had positive or negative experiences before helps therapists calibrate their approach and avoid repeating what didn't work.
frame this as standard practice for all clients rather than singling out clients who may be at risk, which can feel stigmatizing.
arriving prepared lets the therapist spend the session hour building rapport rather than gathering background facts.
Collects presenting concerns, symptom picture, and therapy goals for adults entering individual outpatient psychotherapy.
Gathers each partner's perspective on relationship strengths and challenges, communication patterns, and goals for couples counseling.
Asks parents to describe the child's presenting concerns, school functioning, developmental history, and family context before the first session.
Uses age-appropriate language to ask teens directly about their concerns, relationships, school stress, and what they hope therapy will help with.
Includes detailed questions about trauma history, current PTSD symptoms, prior treatment attempts, and stabilization resources.
Screens for dissociation, trauma complexity, and stabilization capacity before beginning EMDR reprocessing work.
Captures loss history, relationship to the deceased, grief timeline, and the client's support system during bereavement.
Collects substance use history, prior treatment attempts, current stage of change, and co-occurring mental health conditions.
Gathers employer EAP authorization information alongside presenting concerns for short-term work-focused counseling.
Collects technology comfort level, time zone, preferred appointment times, and communication preferences for virtual therapy clients.
Assesses group fit by collecting interpersonal goals, prior group experience, and comfort with peer feedback before group placement.
Gathers information about anger triggers, frequency and intensity of anger episodes, and any legal or occupational consequences.
Uses inclusive, judgment-free language to collect relationship structure, sexual concerns, medical factors, and treatment goals.
Asks about spiritual practices, religious background, and how faith intersects with the presenting concerns for pastoral or faith-integrated therapy.
A therapy intake form collects background, presenting concerns, and logistics before the first session. A mental health intake assessment is a more formal clinical evaluation (often using standardized measures like PHQ-9 or GAD-7) typically completed with the therapist during the first appointment. You can add standardized screening tools to this form if needed.
formformform has no HIPAA programme or business associate agreement. If your practice is subject to HIPAA, do not use these templates to collect protected health information. You can use non-patient administrative templates for tasks such as supply requests. Review the requirements for your own use before publishing.
Duplicate the template and customize it for each specialty. A couples therapy intake would ask about relationship length, prior counseling, and each partner's goals. A child therapy version would collect parent information and developmental history.
Currently forms must be completed in one session, so advise clients to set aside 10-15 minutes before starting.
The form is not a substitute for a real-time clinical assessment of safety. If you are concerned about a client's safety, contact them directly before their scheduled appointment. You can add a note in the form instructions recommending clients call 988 or 911 for immediate crises.
Yes. Create multiple versions of this template — one for individual clients, one for couples, one for adolescents — and send the appropriate link based on the appointment type.
Collect patient info, medical history, and insurance before the appointment.
Gather presenting concerns, history, and safety information before first mental health appointments.
Take appointment requests with date, time, service type, and reason.
Collect informed consent and appointment details before virtual visits.
Collect complete patient medical history before appointments.
Collect patient history and chief complaint before chiropractic visits.
Gather client history and communication concerns before a first speech therapy session.
Collect only what a first visit needs, plus a privacy acknowledgement.
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