The intake form is the first clinical document a client sees. It shapes their first impression of how you work — and it gives you the information you need to walk into the first session prepared rather than starting from zero.
Most intake forms are either too long (clients abandon them) or too short (you learn almost nothing useful). This guide covers every section that matters, why it matters, and what good questions look like — plus a complete template and filled example.
Intake form vs. intake notes: what’s the difference
These are two separate documents that serve different purposes.
The intake form is filled out by the client — before the first session or at the start of it. It collects factual information: contact details, presenting concern, history, current functioning, emergency contact, and consent.
The intake note is written by the therapist after the first session. It documents your clinical observations, preliminary formulation, risk assessment, and the treatment direction you’re considering.
Both belong in the client record. Neither replaces the other.
What every therapy intake form needs
1. Contact and basic information
Name (or preferred name), date of birth, contact details (phone, email), and how they prefer to be reached. If you work with minors: parent/guardian contact.
Why it matters: Practical necessity — but also the first signal to the client that you care about how they want to be contacted, not just that they show up.
2. Emergency contact
Name, relationship, phone number. Whether you are authorized to contact them.
Why it matters: Required for crisis situations. Asking at intake — rather than in a moment of crisis — is both clinically and practically sound.
3. Presenting concern
“What brings you to therapy at this time? Please describe in your own words.”
Give enough space for a real answer — at least 4–6 lines. Don’t pre-structure this with checkboxes.
Why it matters: The client’s own language for their problem is clinical data. “I feel like I’m disappearing” tells you something that a checkbox for “depression” doesn’t.
4. History of the presenting concern
- When did this start or become more significant?
- Has anything similar happened before? How did it resolve?
- What has already been tried (self-help, previous therapy, medication)?
Why it matters: Context shapes everything. The same presenting concern means something entirely different at first occurrence vs. recurrence.
5. Previous therapy and psychiatric history
- Have you worked with a therapist or counselor before? When, for how long, and what was helpful or not?
- Have you seen a psychiatrist or been prescribed psychiatric medication? Are you currently taking any?
- Any hospitalizations for mental health?
Why it matters: Previous therapy experience — especially what was and wasn’t helpful — is one of the most useful things you can know before the first session.
6. Medical history and current medications
- Current medical conditions
- All current medications (including supplements)
- Any recent significant physical health changes
Why it matters: Medication can affect presentation significantly. Certain medical conditions can present with psychological symptoms. You need to know.
7. Substance use
“Please describe your current use of alcohol, cannabis, or other substances.”
Ask directly, in plain language, without euphemism.
Why it matters: Substance use and mental health are frequently comorbid. Clients often don’t volunteer this information — they wait to be asked.
8. Suicidal ideation and self-harm history
“Have you ever had thoughts of ending your life or harming yourself? If yes, please describe briefly (past or present).”
This question belongs on the intake form. Not asking it doesn’t protect anyone — it just means you’re asking it cold in the first session instead.
Why it matters: History of suicidal ideation is one of the strongest predictors of future risk. You need this baseline.
9. Standardized screening measure
Include PHQ-9 (depression), GAD-7 (anxiety), or both depending on your practice context. These take 2–3 minutes to complete and give you objective baseline scores to track over time.
Why it matters: “Client appears to have improved” is not clinical data. PHQ-9: 17 → 9 over 8 sessions is.
10. Current functioning
- Sleep (quality, hours per night)
- Work or school functioning
- Relationships (any significant concerns)
- Daily activities (what’s been affected by the presenting concern)
Why it matters: Functional impact is often a better indicator of severity than symptoms alone. A GAD-7 of 10 looks different when it’s not affecting functioning vs. when the client hasn’t left the house in two weeks.
11. Goals for therapy
“What would you like to be different as a result of therapy? How will you know it’s working?”
Why it matters: The client’s own goals — in their own language — become your outcome markers. “I want to be able to drive again” is more useful than “reduce avoidance behavior.”
12. Consent and agreements
- Confidentiality and its limits
- Fee structure and cancellation policy
- If telehealth: platform, consent for video sessions
- Authorization for release of information (if applicable)
Ready-to-use intake form template
THERAPY INTAKE FORM
[Practice Name] | [Date]
─── PERSONAL INFORMATION ───────────────────────────
Name (or preferred name):
Date of birth:
Phone: Email:
Preferred contact method:
Pronouns (optional):
─── EMERGENCY CONTACT ──────────────────────────────
Name: Relationship:
Phone:
May I contact this person in a clinical emergency? Yes / No
─── PRESENTING CONCERN ─────────────────────────────
What brings you to therapy at this time?
(Please describe in your own words)
When did this begin or become more significant?
─── HISTORY ────────────────────────────────────────
Have you been in therapy before? Yes / No
If yes: when, how long, and what was helpful or not:
Have you worked with a psychiatrist or been prescribed
psychiatric medication? Yes / No / Currently
If yes or currently, please describe:
Current medications (all, including supplements):
Any hospitalizations for mental health? Yes / No
If yes, when and for what:
─── HEALTH AND SUBSTANCES ──────────────────────────
Current medical conditions:
Alcohol use (frequency / amount per week):
Cannabis use:
Other substances:
─── SAFETY ─────────────────────────────────────────
Have you ever had thoughts of ending your life or
harming yourself? Yes / No / Currently
If yes, please describe briefly:
─── CURRENT FUNCTIONING ────────────────────────────
Sleep (hours per night / quality):
Work or school (any significant impacts):
Relationships (any significant concerns):
What has been most affected by what brings you here:
─── GOALS ──────────────────────────────────────────
What would you like to be different as a result
of therapy?
How will you know it's working?
─── SCREENING MEASURES ─────────────────────────────
PHQ-9: [attach or insert here]
GAD-7: [attach or insert here]
─── CONSENT ────────────────────────────────────────
I have read and understood the practice's confidentiality
policy and limits of confidentiality. ☐
I understand the fee structure and cancellation policy. ☐
[If telehealth] I consent to telehealth sessions via
[platform]. ☐
Signature: Date:Filled example
THERAPY INTAKE FORM Date: 05/21/2026
Personal information: Name: M.K. | DOB: 04/15/1995 | Phone: [redacted] | Email: [redacted] Preferred contact: text | Pronouns: she/her
Emergency contact: Partner — J.K. | [phone] | Yes, may be contacted
Presenting concern: “I’m anxious all the time and I can’t relax. Even at home I feel like I’m waiting for something to go wrong. It’s been getting worse since I started a new job four months ago.” When did it begin: approximately 4 months ago; anxiety has been present her “whole life” but recently worse.
History: Previous therapy: No. Psychiatric medication: No. Current medications: Magnesium (self-prescribed for “anxiety”). No other medications. Hospitalizations: None.
Health and substances: Medical conditions: None significant. Alcohol: 1–2 drinks, socially, 1–2x per month. Cannabis: None. Other substances: None.
Safety: Suicidal ideation: No, never.
Current functioning: Sleep: approximately 5–6 hours, difficulty with initial sleep onset. Work: functioning but describes high stress; managing a team for the first time. Relationships: partner is supportive; “doesn’t fully understand why I need therapy.” Most affected: sleep, ability to be present at home; “I bring work anxiety home with me.”
Goals: “I want to stop feeling like something bad is about to happen. And I want to be able to turn off at the end of the day.” How will you know it’s working: “If I can fall asleep without lying there for two hours, that’s a start.”
Screening measures: PHQ-9: 8 | GAD-7: 14
Consent: All three boxes checked. Signed 05/21/2026.
Common intake form mistakes
Making it too long. A 6-page intake form is a barrier, not a tool. If you’re asking about childhood attachment patterns on the intake form, you’re collecting information the client isn’t ready to give yet.
Not asking about suicidality. This is the most consequential omission. Ask directly. The question doesn’t plant the idea — it signals that you take safety seriously.
No standardized measures. Without a PHQ-9 or GAD-7 baseline, you have no way to measure whether treatment is working. Collect it at intake.
Generic goals questions. “What are your goals for therapy?” gets generic answers. “What would you like to be different? How will you know it’s working?” gets specific, measurable answers.
Confusing form and notes. The intake form is the client’s self-report. The intake note is your clinical interpretation. Don’t combine them — they serve different purposes and have different authors.
TheraMemory includes a structured client record that keeps intake information, session notes, and progress measures in one place — no separate folders, no hunting for the form you sent three months ago.
Try TheraMemory free for 14 days
Structured client records with intake data, session chronology, and standardized scale tracking — ready from day one.
Walk into every first session prepared.
Try TheraMemory