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Counseling Intake Form

Gather essential client details, mental health history, and therapy goals with this counseling intake form. Ideal for counselors, therapists, and mental health professionals in any practice setting.

3 minutes to complete

Eligibility

To complete the Counseling Intake Form, individuals must be at least 18 years old, willing to participate in counseling sessions, and able to provide accurate and honest information about their mental health history and current concerns.

Questions for Counseling Intake Form

Questions

1.

Contact Details

2.

Are you currently employed or in school?

The answer should be a single choice:
  1. Yes
  2. No
3.

Where are you currently employed?

The answer should be a text input.
4.

Primary Reason for Seeking Counseling

The answer should be a single choice:
  1. Stress management
  2. Relationship issues
  3. Anxiety or depression
  4. Career guidance
  5. Grief and loss
  6. Personal development
  7. Family conflicts
  8. Trauma or abuse recovery
  9. Substance abuse
  10. Self-esteem improvement
5.

How long have you been experiencing this concern?

The answer should be a single choice:
  1. Less than a week
  2. 1 to 4 weeks
  3. 1 to 3 months
  4. 3 to 6 months
  5. More than 6 months
6.

Have you seen a counselor or therapist before?

The answer should be a single choice:
  1. Yes
  2. No
7.

When was your recent session?

The answer should be a text input.
8.

Are you currently taking any medications?

The answer should be a single choice:
  1. Yes
  2. No
9.

Please list your Medications:

The answer should be a text input.
10.

Do you have any medical conditions or allergies?

The answer should be a single choice:
  1. Yes
  2. No
11.

If yes, please explain:

The answer should be a text input.
12.

How would you rate your current stress level?

The answer should be a rating.
13.

Anything else you’d like your counselor to know?

The answer should be a text input.

Forms Similar to Counseling Intake Form

  • Therapy Evaluation Form
  • Mental Health Assessment Form
  • Client Information Form
  • Initial Consultation Form
  • Treatment Plan Form
  • Wellness Questionnaire

Here are some FAQs and additional information
on
Counseling Intake Form

Why do I need to complete a counseling intake form before my first session?

The form gives your counselor important background—personal history, presenting concerns, and therapy goals—so your first session can focus on meaningful conversation rather than basic data gathering.

What kind of information is included in the counseling intake form?

The form typically asks for personal details, mental health history, current challenges, medications, and what you hope to achieve through counseling.

Do I need to fill out a new form for each counseling session?

No, you usually only need to complete the intake form once before your first session. Updates may be requested if your situation changes.

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