Skip to main content
Headway

Running a practice

What to include in a client intake form (with examples and templates)

Intake forms are critical to gathering key information from a new client. Our guide offers templates and examples to simplify your client onboarding process.

May 29, 2025

By Dr. Anum Ali, LPC

11 min read

By Dr. Anum Ali, LPC

Intake forms are a foundational part of starting therapy with a new client — but they can also be a point of uncertainty for many providers. What questions are essential? What language should you use? And how do you ensure your intake form is thorough, legally sound, and client-friendly?

Whether you're launching a new private practice or refining your onboarding process, we’re covering what you need to know. We’ll walk through core intake form components, share templates for different specialties, and offer tips for keeping things compliant and compassionate.

Practice in-network with confidence

Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.

Talk to a practice consultant

Understanding therapy intake forms

A therapy intake form is more than just paperwork. It's the starting point for understanding your client’s background, current concerns, and treatment goals. A strong intake form balances clinical necessity with approachability, helping you build trust from the very beginning.

Your intake process may vary depending on your setting and client population, but most forms aim to collect four key types of information:


  1. Personal and demographic details
  2. Mental and physical health history
  3. Presenting concerns and goals
  4. Legal and insurance information

Components of effective therapy intake forms

An effective intake form gives you a clinical foundation while creating a welcoming first interaction for your client. Here’s a deeper look at what your form should include and how to make it more impactful. If you’re looking for more documentation support, read our guide to intake sessions.

Basic client information

Start with essentials: full name, date of birth, pronouns, address, phone number, emergency contact, and preferred method of communication. Consider also asking:

  • "What name would you like me to use in sessions?"
  • "Is it okay to leave a voicemail or send text messages?"

These questions build rapport and help avoid early missteps.

Medical and mental health history

Ask about current medications, past diagnoses, substance use, and hospitalizations. Consider phrasing like:

  • “Have you ever worked with a therapist or psychiatrist before? If so, what was helpful or unhelpful?”
  • “Are there any physical health conditions that may affect your emotional well-being?”

This gives you insight into previous interventions and red flags while showing sensitivity to holistic care.

Current symptoms and concerns

This is where clients tell you what’s happening now. Use a mix of open-ended prompts and simple checklists:

  • “What brings you to therapy at this time?”
  • “Please check any of the following you’re currently experiencing: Sleep issues, panic attacks, loss of interest, self-harm thoughts…”

Some clients will write paragraphs; others will circle three boxes. That’s okay. Your form should support both.

Treatment goals

Encourage clients to think forward:

  • “What would you like to be different in your life six months from now?”
  • “Are there specific skills or coping strategies you’d like to build?”

Understanding their vision helps you align your clinical work with their motivation.

Emergency contacts

Include fields for a trusted contact, their relationship to the client, and a note about when you’d use that contact. Be clear about boundaries: “This person may only be contacted if there is concern for your safety.”

Insurance information

If you’re in-network, collect:

  • Insurance provider and plan
  • Policy and group number
  • Subscriber name and date of birth

Include a brief explanation of your billing policy, what clients are responsible for, and a consent to bill insurance.

Legal and ethical considerations

Every intake form should include components that meet legal, ethical, and documentation standards. These protect both the client and the provider. A few essentials:

  • HIPAA notice of privacy practices: This is required for all providers. You should inform clients how their data is stored, used, and protected.
  • Informed consent to treatment: This should cover therapeutic methods, limits of confidentiality, risks and benefits of treatment, cancellation policies, and the right to withdraw from care.
  • Confidentiality exceptions: Outline when you are legally required to break confidentiality (e.g., risk of harm, abuse disclosure).
  • Recordkeeping disclosure: Let clients know how long records are maintained and how they can request access.


Headway offers templates and compliance guidance, so you have support whenever you need it.

Types of therapy intake forms by practice

Different types of therapy require different intake considerations. Here’s how to tailor your intake forms for each setting.

Individual therapy intake forms

These are the most flexible and widely used. Include space for symptom history, trauma exposure, past therapy experience, and coping tools. Also allow for personalization by asking something like “What’s something you’d like me to know that might not show up on a form?”

Couples therapy intake forms

Couples forms should include each partner’s background, relationship timeline, shared concerns, and individual goals. 

Group therapy intake forms

For group intake forms, include questions about comfort in group settings, goals for participation, and any past group experiences. Clearly state group confidentiality norms and participation guidelines.

Child and adolescent therapy intake forms

These should be filled out by the caregiver and can cover:

  • Developmental history
  • School behavior and supports
  • Family structure and dynamics
  • Medical/mental health background

Be sure to include consent for treatment and a minor assent form.

Best practices for creating client-friendly intake forms

Your intake form is often a client’s first interaction with your practice. Make it count. Here’s how:

Use clear, inclusive language.

Avoid clinical jargon and use client-first phrasing. Replace “Presenting problem” with “What brings you to therapy?” and “Marital status” with “Relationship status (check all that apply).” Include open fields for pronouns, chosen name, and gender identity. Show from the beginning that your space is affirming.

Prioritize question phrases.

For example, instead of “List all psychiatric medications you are currently taking,” you could say, “Are you currently taking any medications related to mental health? If yes, please list them.”

Similarly, instead of “What is your diagnosis?” you could say, “Have you ever received a mental health diagnosis? If yes, please share it below.”

Streamline the format.

Use clear section headers and avoid long, dense paragraphs. Break up questions and use white space to reduce cognitive overload. If digital, ensure your form is mobile-friendly.

Make it optional when appropriate.

Let clients know they can leave certain non-critical questions blank and revisit them later. This builds psychological safety. These shifts help reduce shame and promote openness.

Address privacy concerns.

Clients may feel nervous about sharing sensitive information up front. You can proactively address those concerns by sharing how their data is stored and protected, clarifying who will see the intake form (e.g., just you, your billing team), and reassuring clients they can update or discuss sections in session. When clients understand the purpose behind each question, they're more likely to respond honestly and completely.

General adult therapy intake template

Headway’s intake form template can help therapists navigate sessions with confidence and clarity. 

Get the template

Client information

Full Name:

Date of Birth:

Age:

Pronouns:

Gender Identity:

Address:

City:

State:

Zip:

Email:

Phone:

OK to leave voicemail?:

OK to text?:

Preferred method of contact:

Emergency Contact Name:

Relationship:

Phone:

Referral and reason for seeking services

How did you hear about this practice?:

Briefly describe your reasons for seeking therapy:

What are your goals for therapy?

Mental health history

Have you ever seen a therapist or counselor before?:

If yes, when and for what reason?:


Have you ever been hospitalized for mental health concerns?:

If yes, please explain:


Current mental health symptoms (check all that apply):

  • Anxiety
  • Depression
  • Trauma/Abuse
  • Panic Attacks
  • Mood Swings
  • Sleep Issues
  • Suicidal Thoughts
  • Self-Harm
  • Substance Use
  • Relationship Issues
  • Stress
  • Other:


Have you ever engaged in self harm?:

If yes, when?:


Have you ever attempted suicide?:

If yes, when?:


Have you experienced any major life changes or losses recently?:

If yes, please describe:

Medical history

Primary care provider name & contact:

Current medical conditions or diagnoses:

Current medications (include dosage & reason):

Do you have any allergies (medication, food, etc.)?:

Substance use

Do you currently use any of the following?

  • Alcohol – How often?
  • Tobacco – How often?
  • Cannabis – How often? 
  • Other substances (prescription or illicit):

Have you ever had concerns about your substance use?:

Family & social history

Relationship status:

  • Single
  • Married
  • Divorced
  • Partnered
  • Widowed
  • Other: 


Children (names & ages): 


Who lives in your household?:


Support system (friends, family, community):


Religious or spiritual affiliation (if any):


Cultural or identity factors important to your care (race, ethnicity, gender identity, immigration, etc.):

Employment & education

Occupation:

Employer:

Currently working?:


Highest level of education completed:

  • High school
  • Some college
  • College degree
  • Graduate degree
  • Other: 

Insurance & billing information (if applicable)

Insurance Provider:

Policyholder Name:

Relationship to Client:

Member ID:

Group #:

Billing Address: 

Informed consent & signature

  • I understand that the information provided in this form is confidential and will be used for treatment planning and care coordination. I understand that my therapist may discuss relevant information for clinical supervision or as required by law (e.g., danger to self/others, mandated reporting).
  • I consent to participate in therapy services provided by this clinician.


Signature of Client (or Guardian if applicable):

Date:

Telehealth-specific intake form template

Client information

Full Name:

Date of Birth:

Age:

Pronouns:

Gender Identity:

Address:

City:

State:

Zip:

Email:

Phone:

OK to leave voicemail?:

OK to text?:

Preferred method of contact:

Emergency Contact Name:

Relationship:

Phone:

Technology for telehealth

Check off the device(s) you will use for sessions:

  • Smartphone
  • Tablet
  • Laptop
  • Desktop computer


Internet access is:

  • Stable and private
  • Somewhat reliable
  • Unreliable


Preferred Telehealth platform:

  • Zoom (HIPAA-compliant)
  • Doxy.me
  • Google Meet (HIPAA)
  • Other: 


Do you have a private space for sessions?:

Telehealth consent

  • I understand that telehealth services involve the use of electronic communication to enable mental health services at a distance.
  • I understand the limitations of telehealth, including potential risks related to technology (e.g., interruptions, unauthorized access, or miscommunication).
  • I agree to be physically located in the state of ____________ at the time of each session unless otherwise approved by the clinician. (Note: State laws often require the provider and client to be in the same state.)
  • I understand that if I am experiencing a crisis (e.g., suicidal ideation, risk of harm to self or others), I may be referred to local emergency services or in-person treatment.
  • I understand that I may withdraw consent to telehealth at any time without affecting my right to future care or treatment.

Presenting concerns

Briefly describe your primary concerns for seeking therapy:

When did these concerns begin?

What are your goals for therapy?

Mental health history

Have you ever seen a therapist or counselor before?:

If yes, when and for what reason?:


Have you ever been hospitalized for mental health concerns?:

If yes, please explain:


Current mental health symptoms (check all that apply):

  • Anxiety
  • Depression
  • Trauma/Abuse
  • Panic Attacks
  • Mood Swings
  • Sleep Issues
  • Suicidal Thoughts
  • Self-Harm
  • Substance Use
  • Relationship Issues
  • Stress
  • Other:


Have you ever engaged in self harm?:

If yes, when?:


Have you ever attempted suicide?:

If yes, when?:


Have you experienced any major life changes or losses recently?:

If yes, please describe:

Medical & psychiatric history

Current medical conditions:

Current medications (list name, dosage, and reason):

Primary care physician or psychiatrist (name/contact):

Any recent hospitalizations (past 12 months)?:

Substance use

Do you currently use any of the following?

  • Alcohol – How often?
  • Tobacco – How often? __________
  • Cannabis – How often? __________
  • Other substances (prescription or illicit): ____________

Have you ever had concerns about your substance use?:

Social history

Relationship status:

  • Single
  • Married
  • Divorced
  • Partnered
  • Widowed
  • Other: 


Children (names & ages): 


Who lives in your household?:


Support system (friends, family, community):


Religious or spiritual affiliation (if any):


Cultural or identity factors important to your care (race, ethnicity, gender identity, immigration, etc.):

Employment & education

Occupation:

Employer:

Currently working?:


Highest level of education completed:

  • High school
  • Some college
  • College degree
  • Graduate degree
  • Other: 

Insurance & billing information (if applicable)

Insurance Provider:

Policyholder Name:

Relationship to Client:

Member ID:

Group #:

Billing Address: 

Consent & signature

  • I understand that the information provided in this form is confidential and will be used for treatment planning and care coordination. I understand that my therapist may discuss relevant information for clinical supervision or as required by law (e.g., danger to self/others, mandated reporting).
  • I understand and consent to participate in telehealth therapy services. I agree that the information I have provided is accurate and complete to the best of my knowledge.


Client Signature:

Date:


Clinician Signature (upon review):

Date:

Specialized assessment add-ons

These can be included during intake or completed separately. Each serves a specific clinical purpose:

  • PHQ-9: Standardized screening and monitoring of depressive symptoms.
  • GAD-7: Assessment of the severity of generalized anxiety disorder.
  • PCL-5: Evaluation of PTSD symptoms, particularly following trauma exposure.
  • ACE questionnaire: Identification of adverse childhood experiences to support trauma-informed care.
  • Mood charts: Monitoring mood patterns over time, especially for clients with bipolar disorder or affective instability.


Use these tools to deepen clinical understanding, track progress, and support diagnosis when needed.

How Headway simplifies the intake process

At Headway, we know that intake paperwork can be a time-consuming hurdle for clinicians. That’s why we’ve designed tools that help therapists onboard clients with ease and compliance.

As a Headway provider, you get automated client onboarding once a new client is added, electronic intake forms sent directly to clients, and support from practice consultants to make sure your documentation meets clinical and legal standards.

Intake doesn’t have to be intimidating

Headway helps therapists simplify paperwork and manage insurance with ease, so you can welcome new clients without getting buried in forms.

Talk to a practice consultant

This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.

Running a practice