Every individual has different preferences regardless of the identical services that they order to a service provider. This is why service providers include consultations as part of their process to cater their clients’ needs. With this, client intake forms are required to be completed by the client before he will be meeting the provider.
Client Intake Form Sample
What Is a Client Intake Form?
A client intake form is an informational document that allows the service provider to acquire the necessary details and data of his clients. When making an intake form, the service provider must assure that the client is aware of the purpose why he needs to fill out the document. These purposes and objectives can either be informed directly to the client or be stated on the form as part of an informed consent and authorization statement.
General Client Intake Form
Varieties of Client Intake Forms
Since there are several businesses and service providing companies, there are also different client intake forms that each company can use. Below are some of the most common varieties:
Bankruptcy Client Intake Form – With this form, the client who is facing a bankruptcy issue will be able to disclose important details about his financial state, properties, and personal circumstances. The client must complete the form with enough details in order to avoid having the bankruptcy consultation and filing process be delayed due to the lack of descriptions and data. The form is also used during the verification procedure of the client’s attorney or financial consultant. Specifically, the form will primarily have the general information of the client which will be followed by the details of the client’s spouse and dependents. The income statement of the client, owned properties, mortgage and collection information, and household inventory are some of the inclusions found on the form.
Bankruptcy Client Intake Form
Enclosed with this type of intake form are debt sheets and statement of affairs forms that the client must complete. The debt sheets will collect the details of the client’s debts which include the names of the creditors whom the client owes a significant amount of money, type of debt, and the dates of when each debt was established. Additionally, the statement of affairs that the client needs to fill out is a questionnaire that will determine whether the client is a part of a joint tenancy agreement, a partner of a specific business, or is a co-owner of a property owned by another party.
Entity Client Intake Form – This form is ideal for clients who represent companies and organizations in the business field. The form must have the company’s information which includes its business type, legal entity type, contact information, and company office address. The kind of advice or consultation services that the company needs will be stated in the form along with the company’s expected outcomes and results for the services requested.
Entity Client Intake Form
Estate Planning Client Intake Form – If an individual owns a real estate, he must secure his property. With this, estate planning consultants and attorneys are the professionals who provide estate planning services in order to help real estate property owners in managing and in distributing their properties after death. The form has sections for the testator’s and his spouse’s as well as children’s information; sets of security and inheritance questions; an area for the testator’s burial plans; and the testator’s asset, liability, and beneficiary designation information. Other inclusions found in the form is the testator’s power of attorney and choice of health care proxy.
Estate Planning Client Intake Form
Although the intention of estate planning is also catered in a last will and testament of an estate owner or testator, there are more benefits that the testator and his family can obtain with a proper estate planning rather than relying on a written testament. One of the most common is protecting the testator’s family from paying large amounts for taxes after the testator’s death.
Landscaping Client Intake Form – Conducting site analysis, inventory, land designing, and planning are the obligations of a landscape consultant. These consultants use landscaping client intake forms which will gather the identification of their clients along with the client’s expected goals, limitation for the project budget, type of consultation service needed, preferred trees and plant designs, as well as an indication of whether the client will be needing an annual service from the consultant for his garden and landscape maintenance.
Landscaping Client Intake Form
Law Office Client Intake Form – Clients who need attorneys for a court trial and other legal matters will have to complete this type of client intake form. The disclosed information in the form will be used by the law office representative in creating documents and determining procedures that are necessary as well as suitable for the client’s needs. Basically, the client will have to indicate his contact information and the type of urgency for the assistance he needed. An acknowledgment statement is included at the end of the form which is significant for informing the client about the importance of a signed written contract agreement between him and the attorney that he will hire for meeting legal requirements.
Law Office Client Intake Form
Medicaid Waiver Client Intake Form – Medicaid is a sort of healthcare program that is provided to eligible individuals in a state. Specifically, a Medicaid waiver client intake form will have the details of the Medicaid holder or client. These details include the client’s Medicaid number and the name of the person who is considered as the client’s authorized representative. The client’s physician’s medical diagnosis for the client’s illness or medical condition is also important to be included on the form along with the type of diet prescribed by the physician. At the bottom of the form, the dates when the referral was received and when the client was contacted by the company is stated along with an indication of whether the client’s data have undergone a status verification or not.
Medicaid Waiver Client Intake Form
Pediatric Client Intake Form – This client intake form will have a child information section along with other details to be completed by the child client’s parents. Most pediatric client intake forms are used by massage therapists and clinics wherein babies are the common clients. The form allows the parent to indicate the allergies of his child, the medications that were recommended by the child’s doctor, the child’s physical and mental health history, and other medical information that are needed to be disclosed to the therapists. Additionally, a parental consent is included on the form which signifies the approval of the parent for the therapist to massage or have the child undergo specific procedures to address the stated medical concerns.
Pediatric Client Intake Form
Sexual Abuse Client Intake Form – Helping rape clients to move on and continue living their lives after traumatizing rape incidents are the duties of some consultants. With this, a sexual abuse client intake form must be completed by either the client or his legal guardian in order to inform the consultant about the concerns and problems. The form will have the client’s basic information, incident data, network contacts, and the summary of the incident. Along with the initial intake form, the consultant must complete a follow-up document after the consultation has been done. This follow-up form will determine what the client’s progress and improvements were after the resolution and action plans were presented to him.
Sexual Abuse Client Intake Form
How to Create a Simple Client Intake Form
Client intake forms can easily be created by any service provider with the help of the steps listed below:
Step 1: Place the logo and name of the company.
The company name and logo will serve as an identification for the document regarding where it must be submitted. Additionally, an area to cater the date of when the client used the form can also be allotted after the logo and name. The date will aid the document-keeper to determine which files will the form be categorized.
Step 2: Indicate the form’s objectives and instructions.
The objectives will inform the client of the company’s goal in obtaining his general information on the form. On the other hand, the instructions will guide the client throughout the process of the completing the document which can also be accompanied by an area of frequently asked questions acquired from the company’s other clients.
Step 3: Begin an area for the client’s personal information.
This is where the client can disclose his full legal name, date of birth, residential address, phone numbers, and his social security number. The client’s health care account identification can also be required in this area if the company is open to providing discounts to those who have health care providers.
Step 4: Add an emergency contact information section.
Regardless if the intake form is from a medical company or from a law firm, this emergency contact section must always be present as an assurance that the company will be able to inform the client’s authorized emergency contact person whenever needed. This section must have the emergency contact person’s name, phone numbers, and the specific relationship that he has with the client.
Step 5: Have a table allotted for the client’s history.
This table must cater all the details that are necessary for helping the service provider in knowing what the client’s issues are. These details can either include the client’s medical history if the company is a health care provider, service history if the company deals with problems relating to the services that they have provided, or the client’s employment history for those who help their client’s career building.
Step 6: Allocate a section for the client’s comments and questionnaire.
Depending on the preference of the company, the form can also have a client questionnaire section that allows a greater range of data to be collected. However, when making the questionnaire, the company must only focus on what is significant for the consultation and what can be beneficial to be used by the service provider or company representatives. On the other hand, the client must have an area where he will state his comments and suggestions of how the company can address his concerns and problems immediately.
Step 7: State an agreement.
There are different types of agreements to be included and enclosed in a client intake form. One of the most common is a confidential agreement statement which protects the client’s data from being disclosed to other parties who are not permitted and authorized. Another is a consent to treat statement which secures that the client agreed and permits the company to provide treatment for him as part of their consultation.
After the agreement, the client must have an area where he can affix his signature and a date of when he completed the form. The client’s signature is an indication that the client agreed to the stated terms and the objective of the intake form as well as the company in obtaining his details.
Confidential Client Intake Form
What Formats to Consider for Creating Client Intake Forms?
Client intake forms can come in a word document, portable document file (PDF), and spreadsheet formats. When choosing a form to be in word document format, the service provider will be assured that they are providing an ease of use to their clients and customers. On the other hand, if it is a portable document file format that is chosen, security and efficiency when used in the service provider’s website are the advantages. Lastly, client intake forms in spreadsheet formats can also be beneficial to the service providers by having automatic calculations for how many clients they have and the readiness of columns and rows in making tables for the document.
Client Intake Form in DOC
Along with the aforementioned formats that are commonly used with computers and new technology gadgets, printed forms can also be better for other service providing companies. A printed intake form can easily be provided upon the client’s arrival at the provider’s office which can be completed by using a simple pen.
Therapeutic Massage Client Intake Form
Simple Client Intake Form
However, regardless of the preferred formats to be chosen by the company, it is significant that the company will keep the form as part of their documentation process and record-keeping procedures. These papers and documents can be used for their inventory as well as surveys relating to the client’s orders, needs, and wants over a specific period of the year.
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