Free Counseling Intake Form Template

Gathering important client information can feel overwhelming, especially when managing multiple patients. This counseling intake form template is designed for therapists and mental health professionals looking to streamline the intake process and enhance client experience. By utilizing this template, you can efficiently collect essential counseling information, reduce administrative tasks, and maintain organized patient records, all while ensuring confidentiality and compliance with regulations. Plus, being WCAG-aligned means you can cater to all clients, enhancing accessibility. Try out the live template to experience these benefits firsthand.

When to use this form

Use this template before a first session to gather essentials and reduce paperwork during the visit. You can collect demographics, presenting concerns, consent, insurance details, and emergency contacts in minutes. It helps private practices, campus centers, and telehealth teams onboard new clients smoothly, whether scheduled or self-referred. When your context is specific, extend it with the School counseling intake form, Couples therapy intake form, or the Intake form for group sessions new client form. You get complete information ahead of time, so you can triage risk, match the right provider, and set clear goals and next steps.

Must Ask Counseling Intake Questions

What brought you to seek support now?
Pinpointing timing and triggers shows urgency and motivation. It helps you set priorities for the first session and choose the right starting interventions.
What are your top 13 goals for the next four to eight weeks?
Clear, short-term goals make progress measurable. They guide your treatment plan and help you align expectations with the client.
How are your symptoms affecting sleep, work or school, and relationships?
Functional impact reveals severity and where support is needed most. It also gives you baseline markers you can track over time.
Are you experiencing any safety concerns, including thoughts of self-harm or harm to others?
Direct safety screening protects the client. If risk is present, you can create a safety plan and adjust care immediately.
What prior services, diagnoses, or medications should we know about?
History prevents repeating what did not work and flags contraindications. It supports coordination with medical providers when needed.

More Forms

Question		Response
Full legal name		John Smith
Date of birth		2025-10-15T00:00:00.000Z
Gender identity		Man
Your pronouns (optional)		This is a test
Address (street, city, state, ZIP)		This is a test
Email address		[email protected]
Phone number		555 555 5555
May we leave a voicemail at this number?		Yes
Emergency contact full name		John Smith
Relationship to you		This is a test
Emergency contact phone		555 555 5555
Are you completing this form for yourself?		No
If not yourself, what is your relationship to the client? (optional)		This is a test
What brings you to counseling at this time?		This is a test
How urgent are your current concerns?		Immediate safety concern
Preferred session type		Phone
Scheduling preferences (select all that apply)		Weekend mornings
Have you received counseling or therapy in the past?		Yes
Diagnoses or concerns you have been told about (if any)		Prefer not to say
Current medications (names and dosages, if known)		This is a test
Relevant medical conditions or allergies		This is a test
Are you currently experiencing thoughts of harming yourself?		Yes
Are you currently experiencing thoughts of harming someone else?		Prefer not to say
Insurance provider name (if applicable)		This is a test
Member or subscriber ID (if applicable)		This is a test
Do you plan to use health insurance for counseling?		Yes
If yes, please describe the accommodations you need		This is a test
Do you require any accessibility accommodations?		No
I have read and agree to the informed consent and privacy practices		1
Appointment reminder methods I prefer (select all that apply)		Phone call
Signature (type your full legal name)		This is a test
Signature date		2025-10-15T00:00:00.000Z
I certify that the information provided is true and complete to the best of my knowledge		False

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Counseling Intake Form Template

Simplify Client Registration with Our Counseling Intake Form

When to use this form

Must Ask Counseling Intake Questions

More Forms

Unlock hundreds more featuresSave your Form to the DashboardView and Export ResultsUse AI to Create Forms and Analyse Results

Counseling Intake Form Template

Simplify Client Registration with Our Counseling Intake Form

When to use this form

Must Ask Counseling Intake Questions

More Forms

Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results