Therapy Intake Form Template

A first therapy hour is short. This therapy intake form template gathers contact details, presenting concerns, and goals ahead of time so you can start with context instead of paperwork.

Great for

• Individual therapists and group practices onboarding new clients
• A pre-session link after the first booking
• Telehealth practices that need intake before video sessions

Keep clinical depth for the session. Use the form for contact safety (emergency contact), presenting themes, and goals, which are enough to plan the first hour.

This sits next to our counseling intake template for couples work. Use this one when the practice is individual mental health rather than relationship-focused.

Questions in this template

1. Full name *
   Name
2. Email *
   Email
3. Phone number *
   Phone
4. Preferred method of contact *
   Multiple choice Phone call, Text message, Email
5. Date of birth *
   Date
6. Emergency contact name *
   Name
7. Emergency contact phone *
   Phone
8. Relationship to you *
   Short text
9. Why are you seeking therapy right now? *
   Long text
10. Which of these feel present for you lately?
    Checkboxes Anxiety or worry, Low mood or depression, Stress at work or school, Relationship or family strain, Trauma or grief, Sleep problems, Something else
11. Have you been in therapy before? *
    Yes or no
12. Are you currently taking medication for mental health? *
    Yes or no
13. What do you hope will be different in a few months? *
    Long text
14. Preferred session format *
    Dropdown In person, Video, Either is fine
15. Anything else we should know before we meet?
    Long text
16. Signature (type your full name) *
    Short text