Template library · Intake forms
Therapy Intake template
Please complete before your first therapy session.
- 15 fields across 3 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
- DateDate
- PractitionerText
Client Information
- Full nameText
- Date of birthDate
- Phone numberText
- EmailText
- Emergency contact (name & phone)Text
Presenting Concerns
- What brings you to therapy?Text
- OtherText
- Overall mood latelyText
- Have you been in therapy before?Choice
- Areas of concern (check all that apply):
- Anxiety
- Depression
- Trauma
- Relationships
- Grief
- Stress
Background & Goals
- Current medicationsText
- What would you like to work on in 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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