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Therapy Intake Form

Start counselling with the context already gathered, gently, so the first session can be a conversation rather than an interview.

Therapy Intake Form

Start counselling with the context already gathered, gently, so the first session can be a conversation rather than an interview.

What brings you here

Background

Practicalities

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Use this template

Opens in the builder. Nothing is saved until you edit it.

Fields
13 questions
Theme
Plum, switchable in the preview
Updated
11 August 2026

Categories

  • Healthcare
  • Healthcare Forms
  • Intake Forms
  • Wellbeing Forms

Ideal for

  • Therapists
  • Counsellors
  • Psychologists
  • Wellbeing services

Best used in

  • First session preparation
  • Private practice
  • Employee assistance

About this template

An intake form for therapy has a harder job than a clinical one. It has to collect enough to prepare for the first session without feeling like a questionnaire that has already decided what is wrong. Every prompt here is open where it can be, the checklists offer a way out, and the first field asks what the person would like to be called rather than their legal name.

The relevant areas checklist gives people vocabulary without forcing a diagnosis, and it ends in an option for something not listed so nobody has to squeeze themselves into a category. Asking whether previous therapy helped or did not suit them is more useful than asking whether they have had any, because the answer tells you what to avoid repeating.

Keep the closing question exactly as broad as it is, since it is where the important thing usually appears. Add a risk screening section if you practise somewhere that requires one, and set the form to notify you rather than sit in a queue.

Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.

Fields in this template

  • Name you would like to be called*Short text
  • Email address*Email
  • Phone numberPhone
  • PronounsDropdown
  • What would you like to work on?*Long text
  • How long has this been going on?Dropdown
  • Which of these feel relevant?Multiple choice
  • Have you had therapy before?Single choice
  • Any medication you are takingLong text
  • Your doctor, if you are happy to shareShort text
  • How would you prefer to meet?*Single choice
  • When are you usually free?Multiple choice
  • Anything else you would like me to know?Long text

Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.

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