Free template
Therapy intake form template
The intake form is the one document nearly every client completes, and it sets the tone for everything after it: it should read like the start of a conversation, not an interrogation. This template covers what a first session actually needs — who the client is, how to reach them, what brings them in, their treatment and medical history, a brief substance-use and safety screen, and the strengths question most forms forget.
Send it before the first appointment so you can read it in advance. Anything a client leaves blank is information too — an invitation to ask gently in person.
The template
[PRACTICE NAME] Confidential Client Intake Form Please complete this form before your first appointment. Everything you share here is confidential and becomes part of your clinical record. If a question does not apply to you, or you would rather talk about it in person, leave it blank. ABOUT YOU Full legal name: _______________________________ Name you go by: ______________________ Date of birth: ____________ Pronouns (optional): ____________ Address: _______________________________________________________________________________ Phone: ____________________ OK to leave a voicemail? [ ] Yes [ ] No Email: ____________________ OK to email you? [ ] Yes [ ] No Preferred way to reach you: [ ] Phone [ ] Text [ ] Email EMERGENCY CONTACT Name: _______________________________ Relationship: ____________________ Phone: ____________________ HOW YOU FOUND US Who referred you, or how did you find this practice? ____________________________________ Primary care provider (optional): ______________________________________________________ May we coordinate care with them if needed? [ ] Yes [ ] No [ ] Let's discuss first WHAT BRINGS YOU IN In your own words, what brings you to therapy right now? ________________________________________________________________________________________ ________________________________________________________________________________________ How long has this been a concern? ______________________________________________________ What would you like to be different when our work together is done? ________________________________________________________________________________________ MENTAL HEALTH HISTORY Have you been in counseling or therapy before? [ ] Yes [ ] No If yes, when, with whom, and what was helpful (or not)? ________________________________________________________________________________________ Have you ever been hospitalized for a mental health concern? [ ] Yes [ ] No If yes, when and where? ________________________________________________________________ Are you currently having thoughts of harming yourself or ending your life? [ ] No [ ] Sometimes [ ] Yes (However you answer, we will make space to talk about this at your first visit.) MEDICAL Current medications, including psychiatric medications and dosages if you know them: ________________________________________________________________________________________ Prescribing provider(s): _______________________________________________________________ Significant medical conditions, past or present: ________________________________________________________________________________________ SUBSTANCE USE Do you currently drink alcohol? [ ] No [ ] Occasionally [ ] Regularly Do you use tobacco, cannabis, or other substances? [ ] No [ ] Yes: ________________________________________________________________________________________ Has anyone ever expressed concern about your use? [ ] Yes [ ] No FAMILY AND RELATIONSHIPS Who do you live with? __________________________________________________________________ Relationship status: ___________________________________________________________________ Any family history of mental health or substance use concerns? ________________________________________________________________________________________ STRENGTHS AND SUPPORTS What is going well in your life right now? ________________________________________________________________________________________ Who or what helps you get through hard times? ________________________________________________________________________________________ Anything else you would like me to know before we meet? ________________________________________________________________________________________ Client signature: _______________________________ Date: ______________
How to use it
- Replace the bracketed placeholders and blanks with your practice details, then put it on letterhead.
- Review every completed form before the first session — especially the safety question. A written endorsement of self-harm thoughts needs same-day follow-up, in person or by phone.
- Pair it with your informed consent and cancellation policy in one intake packet, each with its own signature.
- Drop or reword anything that does not fit your setting — a shorter form that gets completed beats a thorough one that does not.
Common questions
What belongs on the intake form versus the informed consent?
The intake form collects information about the client — history, concerns, contacts. The informed consent explains your policies and gets agreement to them — confidentiality limits, fees, cancellation. Keep them as separate documents: one is data the client gives you, the other is an agreement the client signs, and you will update them on different schedules.
How long should an intake form be?
Two to four pages. Long enough that the first session is not spent collecting phone numbers, short enough that clients actually finish it. Anything you can better explore in conversation — trauma history in detail, for instance — belongs in the session, not on the form. This template deliberately asks broad questions with room to write.
Is it okay to ask about suicidal thoughts on a written form?
Yes — asking about suicidal thoughts does not plant them, and a written screen catches concerns a new client may not volunteer out loud. The key is what you do with the answer: review every intake form before or at the first session, and follow up on any endorsement in person the same day you see it. Never let a form answer sit unread.
Should clients complete this before the first session or in the waiting room?
Before, whenever possible. It gives clients time to think, gives you time to read it and plan the first session, and surfaces safety concerns early. Waiting-room completion works as a fallback, but a rushed form gets you rushed answers.
Do I need a different intake form for minors or couples?
Yes, eventually. A minor intake adds guardian and custody information plus developmental and school history; a couples intake is usually completed by each partner separately. This template is written for an individual adult client — use it as the base and build the variants from it.
Related tools
Prefer not to chase paper? Practice Harbor — an EHR built by a psychologist — sends intake paperwork to clients online and files the completed forms straight into the chart.
More free templates
- Progress Note Template
- SOAP Note Template
- DAP Note Template
- BIRP Note Template
- GIRP Note Template
- Intake Assessment Template
- Treatment Plan Template
- Therapy Superbill Template
- Informed Consent Template
- Telehealth Consent Template
- Safety Plan Template
- Termination Letter Template
- Records Request Response Template
- Supervision Hours Log Template
- Therapy Invoice Template
Browse the full template library → · See our free practice tools →
A starting point, not a finished document: adapt it to your setting and profession, and check it against your licensing board's documentation requirements before you use it with clients.