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Medical formsGeneral (US)Original PDFBetter template

Therapy Intake Form

For therapists, counselors and psychologists starting with a new client. It gathers background and goals before the first session and states the limits of confidentiality clearly. It is not a crisis assessment.

Fields
40
Pages
2
Paper
Letter
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Before you start

What you need to fill it in

  • Client contact details and emergency contact
  • What brings them to therapy and how long it has been happening
  • Previous counseling or psychiatric care
  • Current medications and prescriber
  • Goals for therapy

What's inside

40 fields, ready to fill

  • 17Typed answersnames, addresses, descriptions
  • 2Dateschecked as real dates
  • 20Choicescheckboxes, options, dropdowns
  • 1Signaturessignature and initials

9 required — the editor counts down how many are left while you fill.

Instructions

How to fill out the Therapy Intake Form

  1. 1

    Client details

    Enter contact details, preferred name and pronouns, and how the practice may contact you.

  2. 2

    What brings you in

    Describe your concerns in your own words and check symptoms you have noticed in the last two weeks.

  3. 3

    History

    Note past counseling, hospitalizations and medications.

  4. 4

    Safety questions

    Answer honestly. A yes does not end your care; it helps your therapist support you.

  5. 5

    Goals and consent

    Write what you hope will change, read the confidentiality section and sign.

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What filling it looks like

The PDFBetter editor in Edit & fill mode: an invoice template with the bill-to details and line items typed in, and each amount calculated from quantity and unit price
  1. Edit & fill, Invite to sign and Create form are three modes of the same editor
  2. Amounts are formula fields: they calculate as you type
  3. The field navigator counts what's left and jumps to the next field

Shown with our invoice template. Sample content; names are fictional.

Written for: General (US)

This template is a general starting point, not medical or legal advice. HIPAA, state privacy and consent rules vary; have your compliance lead or a qualified professional review it before use.

Written by PDFBetter and last reviewed October 15, 2026. Spotted a problem? Tell us.

Therapy Intake Form: questions people ask

What if a client marks yes on the safety questions?

The clinician should follow up promptly using the practice's risk assessment protocol. The form includes 988 crisis line information for clients in the US.

What are the limits of confidentiality?

Generally, therapists may need to share information to prevent serious harm, report suspected abuse of a child or vulnerable adult, or respond to a court order. Exact rules depend on the state and profession.

Can minors fill this form?

A parent or guardian usually signs for a minor, but some states let minors consent to counseling on their own at certain ages.

Is it safe to send this form by email?

Use a secure method approved by the practice. Ordinary email is not encrypted end to end; protect the PDF with a password if sending.

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