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School Counseling Intake Form Template

Streamline your counseling process with this effective intake form template.

Creating a welcoming environment for new students can be tough when you lack important background information. This School Counseling Intake Form Template helps you efficiently collect crucial details about students' backgrounds, concerns, and needs before their counseling sessions. You'll benefit from improved communication, tailored support plans, enhanced rapport with students, and streamlined data collection-all while ensuring WCAG-aligned labels that enhance accessibility. Explore this live template to see how it works for your school.

Use this Template (FREE) Live Preview
Student full name
Date of birth
Gender identity
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
If you prefer to self-describe your gender, please enter it here (optional)
School name
Current grade
Parent/guardian full name
Relationship to student
Parent/guardian email
Parent/guardian phone
Who is completing this form?
Student
Parent/Guardian
Teacher/Staff
Administrator
Counselor
Other
Please Specify:
Primary reason for referral
Presenting concerns (select all that apply)
Please Specify:
Does the student have an IEP or 504 plan?
Yes
No
Unsure
Academic performance concerns
No concerns
Mild concerns
Moderate concerns
Significant concerns
Not applicable
Attendance concerns
No concerns
Mild concerns
Moderate concerns
Significant concerns
Not applicable
Are there any current thoughts about harming self?
Yes
No
Prefer not to say
If there are immediate safety concerns, please describe
Are there any current thoughts about harming others?
Yes
No
Prefer not to say
Preferred meeting format
In person at school
Video/online (if available)
Phone (if available)
No preference
Best times to meet
Before school
Morning
Midday
Afternoon
After school
During lunch
Not sure
Preferred contact for scheduling
Parent/Guardian
Student
Both
Preferred contact method
Email
Phone call
Text message (if available)
School messaging platform
Note sent home
Other
Please Specify:
Language preference
English
Spanish
Chinese
Arabic
French
Prefer not to say
Other
Please Specify:
Accessibility or accommodations needed
Interpreter
Wheelchair access
Quiet/low-stimulus space
Extended time
Visual supports
None
Other
Please Specify:
Permission to coordinate with relevant school staff about this concern
Yes
No
Name of person giving consent
Signature (type your full legal name)
Signature date
I understand the general limits of confidentiality in school counseling
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Emergency contact full name
Relationship to student
Emergency contact phone
{"name":"Student full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Student full name, Date of birth, Gender identity","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Colorful paper art illustration depicting a school counseling intake form for an article on FormCreatorAI

When to use this form

Use this form when a student or caregiver requests support, a teacher refers a student for behavior changes, or after a student returns from a crisis or suspension. It helps you triage urgency, gather context, and set clear goals for one-on-one or group support. You can also route students to the right service and document consent for contact and coordination. For group programs, use Intake form for group sessions new client form to onboard students smoothly. When cases involve home services, Social worker intake form covers household and services details. For external partners or private practices serving students, Counseling intake form offers a clinic-ready version.

Must Ask School Counseling Intake Questions

  1. What is your main concern or goal for counseling?

    This pinpoints why you are seeking help and sets a clear target for progress. It guides which supports to offer first and how to measure improvement.

  2. How can we reach you and your parent or guardian, and what is your preferred contact method and language?

    Accurate contacts and preferences let us follow up quickly and get consent without delays. It also reduces missed appointments and ensures you receive updates in a way that works for you.

  3. Are you receiving any supports (IEP/504, tutoring, or outside counseling), and may we coordinate with those providers?

    Knowing current services prevents duplicate plans and aligns goals across teams. If a clinic is also involved, reviewing the Psychotherapy intake form can streamline handoffs and expectations.

  4. When did this start, how often does it occur, and what triggers or helps?

    Timeline and patterns help you judge urgency and select the right interventions. Prior strategies reveal coping skills you can reinforce and gaps you need to address.

  5. Do you have any immediate safety concerns, such as bullying, self-harm, harm to others, or abuse?

    This prioritizes risk assessment and ensures you follow required reporting and crisis protocols. It supports a rapid safety plan to protect the student and others.

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