Free Family Therapy Intake Form Template

Gathering essential information can be tough for families beginning their therapy journey. This Family Therapy Intake Form Template is designed to help therapists collect relevant details from clients, ensuring a smoother onboarding process. By utilizing this effective template, you can enhance communication, save time during initial consultations, and tailor your approach to each family's unique needs and dynamics. Use it to gain insights into family backgrounds, relationship dynamics, and specific concerns, all while meeting compliance standards with WCAG-aligned labels. Explore the live template to see how it works!

When to use this form

Use this template before a first family session, during case transfers, or when restarting services after a break. It helps you capture who is in the household, the main concerns, safety risks, schedules, and consent in one pass. Scenarios include co-parenting conflict, a teen's school refusal, blended-family stress, or grief after a loss. Clear intake data lets you triage urgency, set shared goals, and choose an approach that fits the system. If you also run individual sessions, pair this with the Counseling intake form; for general practice onboarding, the Client intake form keeps admin details consistent.

Must Ask Family Therapy Intake Questions

What brings your family to therapy now, and what changes do you want in the next 48 weeks?
This pinpoints the trigger and defines short-term goals you can measure. It sets shared expectations and informs session structure; if you also collect individual history, the Psychotherapy intake form complements these goals.
Who lives in your household, and how do you each handle daily roles and routines?
Knowing the household map and responsibilities reveals patterns that maintain or reduce conflict. It guides who should attend, scheduling, and homework that fits real life.
How do conflicts typically start, escalate, and get resolved at home?
Sequence details expose triggers, power struggles, and repair attempts. You can target specific moments for skill-building and interrupt unhelpful cycles.
Has anyone received mental health diagnoses, therapy, or medications in the past?
History prevents repeating what did not work and highlights helpful strategies. For diagnostic context you can align with the Psychology intake form across your practice.
Are there any safety concerns (violence, self-harm, substance use), and who is in your support network?
This lets you set safety plans, coordinate with schools or physicians, and prioritize sessions. Clear risk and supports inform consent, crisis steps, and referrals if needed.

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Question		Response
Primary contact full name		John Smith
Your role in the family (e.g., parent, guardian, partner)		This is a test
Email		[email protected]
Phone		555 555 5555
Preferred contact method		Text message
Is it okay for us to leave messages about scheduling on your phone or email?		Yes
List all family members who will participate (name, age, pronouns, relationship)		This is a test
Are there any custody or legal guardianship considerations we should be aware of?		Not applicable
If language access/interpreter is needed, please specify language (optional)		This is a test
Barriers or accommodations needed for participation (select all that apply)		Internet/technology
What are the main concerns bringing your family to therapy? (select all that apply)		Blended family adjustment
What would you like to achieve in therapy?		This is a test
How long have these concerns been present?		Less than 3 months
Has anyone in the family participated in therapy before?		No
How did you hear about our practice?		School
Are there any current safety concerns in the home (e.g., violence, abuse, unsafe environment)?		Yes
Is anyone currently at risk of harming themselves or others?		Yes
Relevant medical or mental health diagnoses, conditions, or allergies (optional)		This is a test
Current medications and dosages (optional)		This is a test
Do you consent to us coordinating care with other providers if needed?		Not sure
Insurance provider/plan (if applicable)		This is a test
Member ID (if applicable)		This is a test
Do you plan to use insurance for therapy?		Yes
Preferred session format		In person
Which days generally work for you? (select all that apply)		Sunday
What times generally work for you? (select all that apply)		Afternoon
Emergency contact name, relationship, and phone		This is a test
Appointment reminders		Yes, by email
Primary language(s) spoken at home		This is a test
What age ranges are represented among participants? (select all that apply)		Under 18
I have reviewed and consent to family therapy services, including risks, benefits, and limits of confidentiality.		No
I acknowledge receipt of the Notice of Privacy Practices (HIPAA).		No
Telehealth consent (if telehealth is used).		No
I understand and accept financial responsibility and the cancellation/no-show policy.		Yes
If participants include minors, I am a legal guardian and consent to their participation.		Yes
Signature (type full name)		This is a test
Date signed		2025-10-15T00:00:00.000Z

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Family Therapy Intake Form Template

Streamline the intake process for family therapy with this template.

When to use this form

Must Ask Family Therapy Intake Questions

More Forms

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

Family Therapy Intake Form Template

Streamline the intake process for family therapy with this template.

When to use this form

Must Ask Family Therapy 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