Therapy intake form

The risk question has to be asked, and asked carefully

Every intake form for therapy has to screen for current suicidal ideation, and how it is asked changes the answer. A yes/no box gets a no from people who would have said more given room. Four options — including "I would rather discuss this in session" — give somebody a way to flag it without writing it down.

The crisis line belongs beside the question rather than at the end of the form. Somebody answering yes at eleven at night, four days before their first appointment, needs the number where they are, not on page three.

How to contact them is a clinical question

A voicemail on a shared phone or an email that opens on a partner's laptop can matter enormously. Asking which channels are safe, as a checklist that includes "please do not leave a message", is a two-second answer that prevents a serious mistake.

It sits near the top of the form for the same reason: it governs everything the practice does next.

The presenting concern in their own words, first

The symptom checklist is useful and it is not a substitute for the free text. "What brings you to therapy now" gets the sentence the whole first session is built around, and it is frequently not what the checklist would have suggested.

Asking how long, separately, distinguishes an acute change from something lifelong — which is often the first thing you want to know and the last thing a checklist tells you.

What previous therapy taught them is worth more than that they had it

"Yes, and it did not help" is a much more useful answer than "yes", and the follow-up — what was unhelpful about it — is often the single most actionable line on the form. It tells you what not to do in the first three sessions.

Confidentiality limits belong on the intake, not only in the policies

Clients sign a policies document and rarely read it. A separate line acknowledging that confidentiality has limits — risk of harm, mandatory reporting — makes sure the one part that could surprise them later has been seen.

Filled in at home, this form is a different form

An intake this long is unreasonable on a clipboard in a waiting room and entirely reasonable at a kitchen table. Clients write more, write more honestly, and arrive at the first session having already thought about the question.

The answers come back as a spreadsheet and as the completed document, so the record you keep looks like the form you sent. If your practice already uses its own intake paperwork, upload the PDF and it becomes the same link with your own wording — nothing is rewritten.

What this is not

This template is a starting point, not legal or clinical advice, and this service is not offered as a HIPAA-covered platform — there is no business associate agreement. If your practice handles protected health information under HIPAA, check what your obligations require before choosing any tool, including this one. What the service does do with data is written out in full on the security page.