Template library · Intake forms
Universal Intake Form template
Gather core information at the start of care, applicable across service types.
General-purpose new client intake
- 17 fields across 5 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Reason for Seeking Services
- Presenting concernText
- Goals for engaging in servicesText
Background
- Relevant historyText
- Current supports and stressorsText
Risk Flags
- Current safety concernsTick box
- Recent significant life changesTick box
- Prior treatment historyTick box
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
- 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.
Spend less time on admin, more time with clients
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