FREE 6+ Psychotherapy Intake Forms in PDF | MS Word

Psychotherapy intake forms are documents that psychotherapy counselors and advisers use in order to obtain significant details of their clients to aid them in the process of determining a resolution for the client’s issues and concerns. Once the form is submitted, the counselor will then have to key in and note the statements and the disclosed information of the client. After the details are acquired, the form is kept with the client’s other documents such as recommendations and therapy counseling requests forms.

• Medical Intake Forms
• Medicine Patient Intake Forms

Adult Psychotherapy Intake Form

Confidential Psychotherapy Intake Form

Varieties of Psychotherapy Intake Forms

Although psychotherapy has several broad categories which include psychoanalysis therapy and behavior therapy, there are only a few varieties of psychotherapy intake forms that counselors and practitioners use. The most common is known as an adult psychotherapy intake form. Basically, this form is suitable for patients who are no longer in the minority age. Since an adult is already knowledgeable about his/her own well-being and mental state, he/she can fill in the fields of the form without the consent of anyone. However, if an adult patient is dealing with a mental disorder wherein he/she is not capable of supplying his/her own details, then he/she must have a relative or someone who is knowledgeable about his/her personal information and his/her medical condition.

On the other hand, a minor psychotherapy intake form is another document that therapy clinic staffs use but will only be provided for their clients who are still minors and children. The form contains the same sections found in any other psychotherapy intake forms, however, there are added sections and areas that are significant to be completed by the client’s parents. A parent information section for the mother and the father of the client is one of the added sections as well as a minor consent to treat.

Holistic Therapy Intake Form

Minor Psychotherapy Intake Form

Five Steps to Complete a Psychotherapy Intake Form

If you are a psychotherapy client or an authorized relative of a therapy patient, then you must follow the steps below in order for you to effectively complete a psychotherapy intake form:

1. Provide Your General Information – This includes your name, address, and contact information. Some intake forms also demand you to disclose your email addresses, Social Security number, and work information. All of these data and information allows the psychotherapist or the clinic staff to identify you as their client as well as record your details to their system.

2. Enlist Your Emergency Contact Information – The doctor who suggested that you need to go to the psychotherapist’s clinic can also be included as your emergency contact person since he/she is knowledgeable about your condition and has your medical records or initial medical exam results. Additionally, your parents and legal guardian who are available to be contacted whenever there are unexpected incidents in the clinic must be enlisted as well.

3. Answer the Medical Questionnaire – Most questionnaires enclosed or stated in an intake form focus on determining the goals and objectives of taking the therapy sessions. By answering the questions, you will be helping the therapist in knowing what you are feeling and how they can help in addressing your concerns. You may also see counseling intake forms.

4. Disclose Your History – If you have been into a therapy program or an institute where mental health disorders are treated, then you must inform the psychotherapist about the reasons and the medications that you previously took to cure your mental issues. Other history information that you need to indicate on the form includes your criminal and conviction history, and your family history.

5. State Your Strengths and Weaknesses – By honestly disclosing your abilities and limitations, you will be helping the therapist in creating an action plan that will be appropriate for you. You may also see assessment forms for intake.

Psychotherapy Counseling Intake Form

Psychotherapy Intake Form Sample

Client Psychotherapy Intake Form

Some psychotherapy intake forms have an enclosed agreement or consent form, specifically a consent to treat statement. This must be signed by the client in order to allow the psychotherapist to provide medications and medical actions for the client’s treatment program. If the client is a minor, then a parent consent must be attached to the form and the client’s parents must be the one who will sign the agreement.