Counseling intake form template

Create professional therapy intake forms with AI in seconds. Free online form builder for counselors — share digitally and customize for any specialty.

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Who is this therapy intake form for?

This therapy intake form is built for licensed therapists, counselors, psychologists, and mental health practitioners who need to collect comprehensive client information before the first session. Whether you're running a private practice, working at a counseling center, or providing telehealth services, this form streamlines client onboarding by gathering personal details, presenting concerns, mental health history, and consent to treatment in one organized digital format. The form works perfectly for general therapy, couples counseling, child and adolescent counseling, and specialized practices like trauma therapy or substance abuse counseling. Instead of handing clients paper forms or sending PDF attachments via email, you can share a professional intake form link that clients complete on their phone or computer. Responses are automatically organized, making it easy to review client information before sessions and maintain organized client records. The form includes essential fields like emergency contacts, medication history, previous therapy experience, and therapy goals while maintaining a calming, professional appearance that builds trust. No coding required — just customize the fields for your practice, add your branding, and start collecting client information in minutes.

<div class="fields-overview"> <h2>What's included in this therapy intake form template</h2> <div class="fo-card"> <h3>Essential Client Information Collection</h3> <p class="card-desc">Gather complete contact details and emergency information for safe, professional client onboarding.</p> <div class="field-list"> <div class="field-item"> <span class="field-label">Client Full Name</span> <span class="field-badge badge-basic"> <i class="fal fa-font"></i> Short Text </span> </div> <div class="field-item"> <span class="field-label">Date of Birth</span> <span class="field-badge badge-basic"> <i class="fal fa-calendar-alt"></i> Date Picker </span> </div> <div class="field-item"> <span class="field-label">Phone Number</span> <span class="field-badge badge-basic"> <i class="fal fa-phone"></i> Phone Number </span> </div> <div class="field-item"> <span class="field-label">Email Address</span> <span class="field-badge badge-basic"> <i class="fal fa-envelope"></i> Email </span> </div> <div class="field-item"> <span class="field-label">Home Address</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Emergency Contact Name</span> <span class="field-badge badge-basic"> <i class="fal fa-font"></i> Short Text </span> </div> <div class="field-item"> <span class="field-label">Emergency Contact Phone</span> <span class="field-badge badge-basic"> <i class="fal fa-phone"></i> Phone Number </span> </div> <div class="field-item"> <span class="field-label">Relationship to Emergency Contact</span> <span class="field-badge badge-basic"> <i class="fal fa-font"></i> Short Text </span> </div> </div> </div> <div class="fo-card"> <h3>Presenting Concerns and Therapy Goals</h3> <p class="card-desc">Comprehensive assessment of current symptoms, reasons for seeking therapy, and client treatment objectives.</p> <div class="field-list"> <div class="field-item"> <span class="field-label">What brings you to therapy today?</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Are you currently experiencing any of the following?</span> <span class="field-badge badge-choice"> <i class="fal fa-check-square"></i> Multiple Choice </span> </div> <div class="field-item"> <span class="field-label">What are your goals for therapy?</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Rate the severity of your current concerns</span> <span class="field-badge badge-rating"> <i class="fal fa-sliders-h"></i> Scale Rating </span> </div> </div> </div> <div class="fo-card"> <h3>Mental Health and Treatment History</h3> <p class="card-desc">Detailed background on previous therapy, psychiatric medications, and family mental health history.</p> <div class="field-list"> <div class="field-item"> <span class="field-label">Have you received counseling or therapy before?</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> <div class="field-item"> <span class="field-label">Previous therapy experience details</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Are you currently taking psychiatric medications?</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> <div class="field-item"> <span class="field-label">Current medications and dosages</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Have you been hospitalized for mental health reasons?</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> <div class="field-item"> <span class="field-label">Family Mental Health History</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> </div> </div> <div class="fo-card"> <h3>Practice Details and Consent</h3> <p class="card-desc">Insurance information, contact preferences, session format, and required treatment consent.</p> <div class="field-list"> <div class="field-item"> <span class="field-label">Insurance Provider</span> <span class="field-badge badge-basic"> <i class="fal fa-font"></i> Short Text </span> </div> <div class="field-item"> <span class="field-label">Preferred method of contact</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> <div class="field-item"> <span class="field-label">Session Preference</span> <span class="field-badge badge-choice"> <i class="fal fa-dot-circle"></i> Single Choice </span> </div> <div class="field-item"> <span class="field-label">Additional information for your therapist</span> <span class="field-badge badge-basic"> <i class="fal fa-align-left"></i> Long Text </span> </div> <div class="field-item"> <span class="field-label">Consent to receive mental health treatment</span> <span class="field-badge badge-choice"> <i class="fal fa-check-square"></i> Checkbox </span> </div> </div> </div> </div>

FAQ

What is a therapy intake form?

A therapy intake form is a comprehensive questionnaire that new clients complete before their first counseling session. It collects essential information including personal details, presenting concerns, mental health history, medications, emergency contacts, and consent to treatment. This allows therapists to understand their client's background and prepare for the initial session.

What fields should a counseling intake form include?

A complete counseling intake form should include client contact information, emergency contacts, presenting concerns and symptoms, therapy goals, mental health history, current medications, previous therapy experience, family mental health history, insurance information, and informed consent. Multi-page forms help organize this information without overwhelming clients.

Can I customize this therapy intake form?

Yes, you can fully customize this therapy intake form using natural language. Add specialty-specific questions for couples counseling or child therapy, modify consent language for your practice, change colors and fonts to match your brand, and add conditional logic to show relevant questions based on client responses.

Is this therapy intake form free to use?

Yes, this therapy intake form is completely free to create and use. There are no limits on responses or form submissions. You can share it with unlimited clients, collect responses digitally, and export data. The free version includes a small "generated by Weavely AI" badge.

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