Template library · Intake forms
Family Therapy Intake template
Please complete before your first family session.
- 14 fields across 3 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
- DateDate
- PractitionerText
Primary Contact
- Full name (parent/guardian)Text
- Phone numberText
- EmailText
- Family members attending sessions (names & ages)Text
Presenting Concerns
- What brings your family to therapy?Text
- OtherText
- Has the family attended therapy before?Choice
- Which areas are affected? (check all that apply):
- Communication
- Behavior issues
- Sibling conflict
- Divorce/separation
- Grief/loss
- Major life transition
Background & Goals
- Brief description of household/living situationText
- Current family stress levelText
- What would you like your family to gain from 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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