Form templates / Mental Health & Therapy
Therapy Intake Form
A therapy intake form is the bridge between first contact and first session. Enough history to begin safely, and a sense of what this person hopes will change.
For therapists, counsellors and mental-health practices.
Ask what they've already tried
Almost everyone arrives having tried something: a book, an app, a course, a previous therapist, medication, or simply pushing through. Knowing what helped even slightly is more useful than a symptom list, and knowing what didn't saves you from repeating it.
So this template asks directly, along with what they hope will be different. That second answer is the one you'll come back to at review - and clients who have written it down are much better at recognising progress when it happens.
Why ask it all up front
Half-finished information is worse than none: it looks like you can begin, and then you can't. A client who fills in one page has told you enough to quote, schedule and prepare - without a single back-and-forth.
It also sets the tone. A form that asks precisely, and only once, reads as a business that has done this before. That impression is doing real work while your competitor is still emailing "quick question".
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.
It works on a phone, on a bad signal
People fill these in from a car park, a waiting room, a sofa at 11pm. This form is one small page that opens the instant they tap the link and submits without needing anything clever in their browser - so an answer sent on two bars still reaches you.
Edit it like a document, publish like a link
Add questions, remove questions, change the order and the wording, set your accent colour. When you save, the form is live at its own address - share it by link, QR code or a button on your site, and read the answers in your dashboard.
What this template asks
- Your name
- Date of birth
- Email address
- Phone number
- Address
- Emergency contact - name, relationship and number
- Your doctor's practice
- What would you like to work on?
- In your own words, what's going on?
- How long has this been going on?
- How much is it affecting your daily life?
- What have you already tried?
- What would you like to be different?
- Have you had therapy before?
- What was helpful or unhelpful about it?
- Any medication, including for physical health
- Physical health conditions
- Do you use alcohol or other substances to cope?
- How are you sleeping?
- Have you harmed yourself in the last month?
- Have you had thoughts of ending your life?
- Do you have people around you?
- Anything else you'd like me to know before we meet?
More Mental Health & Therapy forms
Questions
How long should an intake form be?
Fifteen questions or so. Long enough to begin safely, short enough to be finished in one sitting by someone who is not feeling their best.
Should risk questions be on the intake form or asked in person?
Both. Asking here means you know before the first session; asking again in person is how you understand the answer. Never rely on a form alone for risk assessment.
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 therapy intake form today
Start from this template and change anything you like. Free to begin.