Intake form templates

Everything you need before a first appointment, by discipline. Every one is included with MyWellOps: edit it, or save your own version for the whole practice.

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Showing all 32 intake forms

Acupuncture Intake
Acupuncture intake covering health history, chief complaint, and a Traditional Chinese Medicine constitutional review.
Contact Info · Health History · TCM Assessment
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
20 fields across 3 sections
Adult Counseling Intake
First-session intake for adult counseling: presenting concerns, symptom areas, history, and goals.
Client Information · Presenting Concerns · Background & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Chiropractic Intake
Chiropractic intake covering pain location, injury history, red-flag conditions, and lifestyle factors.
Contact Info · Health History · Lifestyle & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
17 fields across 3 sections
Client Intake
General-purpose client intake for any practice: contact details, service interest, and health notes.
Contact Info · Service Details · Health & Preferences
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Coaching Intake
Coaching intake capturing focus area, current situation, goals, and commitment level.
Contact Info · Coaching Focus · Goals & Commitment
- Date
- Practitioner
- Full name
- Phone number
- Email
14 fields across 3 sections
Coaching Assessment Intake
Establish context, priorities, and working style at the start of a coaching engagement.
Assessment Details · Current Context · Working Style · Signatures
- Client Name
- Date of Birth
- Client ID / MRN
- Date of Assessment
- Clinician / Coach
15 fields across 4 sections
Couples Therapy Intake
Per-partner couples therapy intake covering relationship history, concerns, and individual background.
Your Information · Relationship Background · Individual Background & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Esthetician Intake
Esthetics intake covering skin type, sensitivities, current products, and treatment goals.
Contact Info · Skin Profile · Treatment Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Facial Treatment Intake
Short facial-treatment intake covering skin profile, contraindications, and appointment preferences.
Contact Info · Skin & Health Profile · Preferences
- Date
- Practitioner
- Full name
- Phone number
- Email
14 fields across 3 sections
Family Therapy Intake
Family therapy intake covering household members, presenting concerns, and shared goals.
Primary Contact · Presenting Concerns · Background & Goals
- Date
- Practitioner
- Full name (parent/guardian)
- Phone number
- Email
14 fields across 3 sections
Full Biopsychosocial Intake
Comprehensive intake covering biological, psychological, and social factors relevant to care.
Assessment Details · Presenting Problem · Biological Factors · Psychological Factors
- Client Name
- Date of Birth
- Client ID / MRN
- Date of Assessment
- Clinician / Coach
23 fields across 4 sections
Health Coach Intake
Health coaching intake covering medical background, daily habits, and wellness goals.
Contact Info · Health Background · Goals & Habits
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Holistic Wellness Intake
Rate your current satisfaction across the following areas of wellbeing.
Assessment Details · Domains of Wellness · Goals · Signatures
- Client Name
- Date of Birth
- Client ID / MRN
- Date of Assessment
- Clinician / Coach
16 fields across 4 sections
Initial Therapy Intake
Gather presenting concerns, history, and goals to establish a therapy treatment plan.
Assessment Details · Presenting Concern · Goals · Risk Flags
- Client Name
- Date of Birth
- Client ID / MRN
- Date of Assessment
- Clinician / Coach
15 fields across 4 sections
Insurance & Consent Intake
Collect consent, policy acknowledgment, and coverage information.
Assessment Details · Consent Items Reviewed · Signatures
- Client Name
- Date of Birth
- Client ID / MRN
- Date of Assessment
- Clinician / Coach
10 fields across 3 sections
Life Coach Intake
Life coaching intake covering a life-domain snapshot, satisfaction ratings, vision, and goals.
Contact Info · Life Snapshot · Vision & Goals
- Date
- Practitioner
- Full name
- Phone number
- Email
14 fields across 3 sections
Massage Therapy Intake
Massage intake covering areas of tension, contraindications, pressure preference, and focus areas.
Contact Info · Health History · Preferences
- Date
- Practitioner
- Full name
- Phone number
- Email
15 fields across 3 sections
Medical Intake
Full medical intake covering demographics, insurance, health history, medications, and current symptoms.
Contact & Demographics · Insurance · Health History · Symptoms & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
22 fields across 4 sections
New Client Intake
Welcome intake for a new client: contact details, referral source, background, and preferences.
Contact Info · Background · Preferences & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
15 fields across 3 sections
New Patient Intake
New patient intake covering personal information, health background, and treatment goals.
Personal Information · Health Background · Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
17 fields across 3 sections
Nutrition Intake
Nutrition consultation intake covering diet history, restrictions, medical background, and goals.
Contact Info · Health & Diet History · Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Personal Training Intake
Personal training intake covering fitness history, injuries, activity level, and training goals.
Contact Info · Health & Fitness History · Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Physical Therapy Intake
Physical therapy intake covering insurance, injury details, pain rating, and functional goals.
Contact & Insurance · Injury/Condition Details · Function & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
18 fields across 3 sections
Psychiatry Intake
Psychiatric evaluation intake covering medication history, prior treatment, safety, and family history.
Contact & Insurance · Psychiatric History · Safety & Family History
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
19 fields across 3 sections
Psychology Intake
Psychology intake covering presenting concerns, symptom areas, mood rating, and treatment goals.
Client Information · Presenting Concerns · Background & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Psychotherapy Intake
Psychotherapy intake covering presenting concerns, prior treatment, medications, and goals.
Client Information · Presenting Concerns · Background & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Reiki Session Intake
Reiki session intake covering energy and wellbeing profile, physical concerns, and session preferences.
Contact Info · Wellbeing Profile · Session Preferences
- Date
- Practitioner
- Full name
- Phone number
- Email
14 fields across 3 sections
Social Work Intake
Social work intake covering presenting needs, benefits and housing status, supports, and goals.
Client Information · Presenting Needs · Background & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
16 fields across 3 sections
Standard Intake
Standard intake form suitable for most practices: contact details, background, and goals.
Contact Info · Background · Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
15 fields across 3 sections
Therapy Intake
Therapy intake covering client information, presenting concerns, mood rating, and therapy goals.
Client Information · Presenting Concerns · Background & Goals
- Date
- Practitioner
- Full name
- Date of birth
- Phone number
15 fields across 3 sections
Trauma-Informed Intake
Gather background sensitively, prioritizing client safety, choice, and collaboration.
Assessment Details · Background · Safety & Stabilization · Signatures
- Client Name
- Date of Birth
- Client ID / MRN
- Date of Assessment
- Clinician / Coach
14 fields across 4 sections
Universal Intake Form
Gather core information at the start of care, applicable across service types.
Assessment Details · Reason for Seeking Services · Background · Risk Flags
- Client Name
- Date of Birth
- Client ID / MRN
- Date of Assessment
- Clinician / Coach
14 fields across 4 sections

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Intake form templates

Acupuncture Intake

Adult Counseling Intake

Chiropractic Intake

Client Intake

Coaching Intake

Coaching Assessment Intake

Couples Therapy Intake

Esthetician Intake

Facial Treatment Intake

Family Therapy Intake

Full Biopsychosocial Intake

Health Coach Intake

Holistic Wellness Intake

Initial Therapy Intake

Insurance & Consent Intake

Life Coach Intake

Massage Therapy Intake

Medical Intake

New Client Intake

New Patient Intake

Nutrition Intake

Personal Training Intake

Physical Therapy Intake

Psychiatry Intake

Psychology Intake

Psychotherapy Intake

Reiki Session Intake

Social Work Intake

Standard Intake

Therapy Intake

Trauma-Informed Intake

Universal Intake Form

Every one of these is included, on the free plan too