Template library · Intake forms
Couples Therapy Intake template
Each partner should complete this form individually before the first session.
- 16 fields across 3 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
- DateDate
- PractitionerText
Your Information
- Full nameText
- Date of birthDate
- Phone numberText
- EmailText
- Partner's nameText
Relationship Background
- How long have you been together?Text
- What brings you to couples therapy?Text
- OtherText
- Have you attended couples counseling before?Choice
- Which areas are you struggling with? (check all that apply):
- Communication
- Trust
- Intimacy
- Finances
- Parenting
- Conflict resolution
Individual Background & Goals
- Any personal mental health history to share?Text
- Current relationship satisfactionText
- What would you like to get out of therapy?Text
- Client signatureSignature
- Date signed (client)Date
When to use it
Send an intake form when a new client books, so their history, contact details and reasons for coming are in front of you before the first appointment rather than taken down during it.
How it works in MyWellOps
- Choose it from Documents and adjust the questions to your practice.
- Send it to the client, who completes it in their client portal.
- Their answers are kept on the client’s record, ready for the first session.
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