3+ Therapy Intake Forms – PDF

Therapists are professionals who help individuals in dealing with personal issues, problems, and the struggles of life. These therapists use therapy intake forms for their clients regardless of the concerns that they will be resolving. The form is intended to collect the general information of the client along with all other relevant data that can help the therapist in developing plans and activities appropriate for addressing a resolution to the client’s complaints.

Therapy Intake Form Sample

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Size: 111 KB

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Individual Therapy Intake Form

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Size: 241 KB

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Significant Contents of a Therapy Intake Form

Although there are varying therapy sessions available globally, therapists must consider to include these significant sections in their intake forms:

1. Contact information

This refers to the client’s contact numbers, email and residential addresses, as well as the client’s emergency contact person. Some therapists also require their clients to disclose two phone numbers as an assurance that the therapist will be able to reach out to the client whenever there are updates and progresses to be discussed.

2. Complaints and Concerns

The client must fully disclose all his complaints and concerns about his/her well-being. The details of when and how the concern started should also be included to allow the therapist in knowing what he/she should plan to resolve and help the client. You may also see the medical intake forms

3. Family History

The client’s family history is necessary for determining if the cause of the client’s concerns is due to his/her family background, especially when the main concern is a medical condition. On the other hand, the family history will also distinguish if a client has been abused and affected by the people in his/her household. You may also like the counseling form

4. Medical History

Some clients deal with severe medical conditions, which is why it is essential that the therapist will be able to acquire sufficient details of the client’s medical information. The client’s allergies, medications, diseases, and symptoms of a possible illness should be stated in this section along with the doctor’s note for further clarifications and evaluation about the client’s health.

5. Personal Development

This section is for the client’s language, speech, and other personally developed aspects. By obtaining a list of the client’s progress and behavioral changes, the therapist will be able to know what strategies are applicable for each planned session, specifically when dealing with the client’s attitude issues. You may also check out the coaching intake forms

6. Skills and Education

By having the client fill in this section, the therapist can enlist activities where the client can maximize the potential of his/her skills, talents, knowledge, and abilities. This aids in constructing a more effective action plan which can smoothen the therapy sessions. You may also see the new patient intake forms

Physical Therapy Patient Intake Form

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Therapeutic Massage Client Intake Form

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Enclosed Documents to a Therapy Intake Form

Since the therapy intake form will gather the personal information of the client, it is significant that the therapist has acquired the client’s legal consent to use all the statements and details that the client disclosed in the form. An informed consent and waiver form should also be enclosed with the therapy intake form to assure that the client has provided the permission for the therapist to use his/her information. The waiver form is also necessary for securing and protecting the therapists and the therapy clinic from liabilities in events of accidents as well as instances when the client is not satisfied with the provided services.

Another document that should be enclosed with the form is an authorization release form which is essential for allowing the therapist in acquiring all relevant details of the client from other sources such as the client’s health care provider and insurance company.

Lastly, an acknowledgment and billing policy statement form will indicate the client’s approval to attend the scheduled sessions and pay the associated bills immediately. This serves as a contract agreement between the client and the therapist that highlights their responsibilities and obligations in the duration of the therapy sessions.

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