Form templates / Mental Health & Therapy
Counseling Intake Form
A counseling intake form is often the first time someone has written any of this down. It should feel like being asked, not being processed.
For therapists, counsellors and mental-health practices.
Short, plain and unintimidating beats thorough
The person filling this in has usually been putting it off for months. A long clinical questionnaire at that moment is the thing that makes them close the tab and try again next year.
So this template asks less than it could. The essentials - what's happening, how long, risk, and what support exists - and then stops. The rest belongs in the room, where you can ask it gently and hear how it's answered.
What a good intake form saves you
The first message from a new client almost never contains what you need. You reply asking one question; they answer a different one; a week later you still can't start. Every round trip is a day, and the clients who go quiet are usually the ones who got tired of answering.
One form ends that. Ask everything once, get a complete picture, and start the same day. The questions in this template are the ones you end up asking anyway - the form just gets them asked up front.
Ask gently, and hold it carefully
A first contact form in this field is often written by someone who has been putting it off for months. Short, plain and unintimidating matters more than thorough - you can ask the rest once there's a relationship.
What it must not do is feel surveilled. These pages carry no analytics, no third-party scripts and no cookie banner, and responses go only to the address you nominate.
Fast enough that people finish it
Abandonment is mostly a speed problem. A form that takes a second to appear and submits in one request gets finished; one that loads a framework first does not. This is a single self-contained page - no scripts to download, nothing to wait for.
Make it yours in a minute
Change the wording, drop the questions you don't need, add the ones you do, put your own colour on it. Saving publishes it, and you get a link to paste into your website, your email signature or a message. Responses land in your dashboard and download as a spreadsheet whenever you want them.
What this template asks
- Your name
- Date of birth
- Email address
- Phone number
- How should we contact you?
- Is it safe to leave a voicemail?
- What would you like help with?
- In your own words, what's going on?
- How long has this been going on?
- What would be different if this went well?
- Have you had counselling or therapy before?
- Are you taking any medication for your mental health?
- Does your doctor know how you're feeling?
- Any physical health conditions we should know about?
- Have you harmed yourself, or thought about it, in the last month?
- Have you had thoughts of ending your life?
- Who supports you day to day?
- Someone we could contact in an emergency
- How would you like to meet?
- When could you come?
- Any preference about who you see?
More Mental Health & Therapy forms
Questions
How do we ask about risk without frightening people?
Ask plainly and without euphemism, and say why you're asking - because it changes how quickly you respond, not whether you'll help. People answer honestly when the reason is visible.
Is a web form private enough for this?
Pages are encrypted in transit and responses go only to the recipients you set. These pages also carry no analytics or trackers at all, which matters for someone who doesn't want a search history.
Can I add or remove questions?
Yes - every question here is a starting point. Add your own, delete what doesn't apply, reorder by dragging, and make anything required or optional. Saving publishes the change immediately.
Where do the answers go?
Into your dashboard, where you can read, filter and export them as a spreadsheet. You can also have every response emailed to you the moment it arrives, or as a daily or weekly digest.
Do I need a website?
No. Every form gets its own link you can paste into an email signature, a text message, a QR code or a social profile. If you do have a site, you can link to it from anywhere on it.
Is this confidential enough for therapy enquiries?
Pages are encrypted in transit and responses stay in your account, going only to the recipients you choose. Keep the form to what you need to make contact, say clearly that it is not for emergencies and where to go instead, and check your professional body's guidance on electronic records.
Publish your counseling intake form today
Start from this template and change anything you like. Free to begin.