Therapy Intake Form
Start counselling with the context already gathered, gently, so the first session can be a conversation rather than an interview.
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Opens in the builder. Nothing is saved until you edit it. Or ask Claude or ChatGPT to build it.
- Fields
- 13 questions
- Layout
- Classic, every question on one page
- Theme
- Plum, switchable in the preview
- Updated
- 11 August 2026
Categories
- Healthcare form templates
- Healthcare Forms
- Intake Forms
- Wellbeing Forms
Form type
Ideal for
- Therapists
- Counsellors
- Psychologists
- Wellbeing services
Best used in
- First session preparation
- Private practice
- Employee assistance
About this template
An intake form for therapy has a harder job than a clinical one. It has to collect enough to prepare for the first session without feeling like a questionnaire that has already decided what is wrong. Every prompt here is open where it can be, the checklists offer a way out, and the first field asks what the person would like to be called rather than their legal name.
The relevant areas checklist gives people vocabulary without forcing a diagnosis, and it ends in an option for something not listed so nobody has to squeeze themselves into a category. Asking whether previous therapy helped or did not suit them is more useful than asking whether they have had any, because the answer tells you what to avoid repeating.
Keep the closing question exactly as broad as it is, since it is where the important thing usually appears. Add a risk screening section if you practise somewhere that requires one, and set the form to notify you rather than sit in a queue.
Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.
Fields in this template
- Name you would like to be called*Short text
- Email address*Email
- Phone numberPhone
- PronounsDropdown
- What would you like to work on?*Long text
- How long has this been going on?Dropdown
- Which of these feel relevant?Multiple choice
- Have you had therapy before?Single choice
- Any medication you are takingLong text
- Your doctor, if you are happy to shareShort text
- How would you prefer to meet?*Single choice
- When are you usually free?Multiple choice
- Anything else you would like me to know?Long text
Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.
Build this form by asking Claude or ChatGPT
Connect Deoochform to Claude, ChatGPT, or any assistant that supports MCP, then send it the message below. It creates the therapy intake form from this template in your account and replies with a link. You can ask it to add, remove, or reword questions in the same chat before you share the form.
Make me a form in Deoochform from your Therapy Intake Form template, then send me the link to share.
New to this? See how to connect your assistant. You sign in with your browser, so there is no key to copy.
Frequently asked questions
- What should a therapy intake form ask?
- What brings them, how long it has been going on, what they want to work on, relevant history, and how they prefer to be contacted. Gently, and with room to skip.
- Should intake questions be optional?
- Mostly yes. A first contact form that insists on an answer to every question loses the people who are least ready to give one, which is usually who it is for.
- Is this confidential?
- Submissions are stored against your account and served over HTTPS. Confidentiality in practice also depends on your own policy and jurisdiction, so state it on the form where the client can read it.
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