What is a psychotherapy intake form used for?

It gathers key client information—such as mental health history, current symptoms, and treatment goals—to help therapists assess needs and prepare for the first session.

Is the information I provide confidential?

Yes. All responses are kept strictly confidential and protected under privacy laws like HIPAA. Only your licensed therapist or clinical team will access this data.

Do I need to complete this form before every session?

No, the intake form is only required before your first session. Therapists may request updates if your circumstances or symptoms change.

Psychotherapy Intake Form

Collect essential client information, including mental health history, presenting concerns, and treatment goals. Designed for psychologists, therapists, and clinical practices offering psychotherapy. Helps streamline assessment and prepare for effective, personalized care from the very first session.

3 minutes to complete

Eligibility

To complete the Psychotherapy Intake Form, individuals must be at least 18 years old, have a desire to engage in therapy, and be willing to provide honest and accurate information about their mental health history, current concerns, and goals for therapy.

Questions for Psychotherapy Intake Form

Patient Details

Briefly describe the main concern(s) that bring you to therapy:

The answer should be a text input.

When did these concerns begin?

The answer should be a text input.

Are you currently taking any medication(s)? If yes, please list:

The answer should be a text input.

Have you previously received counseling or mental health treatment?

The answer should be a single choice:

Do you have any current health conditions or significant medical history?

The answer should be a text input.

How would you rate your current mood?

The answer should be a rating.

Are you experiencing difficulties with (check any that apply):

The answer should be a multiple choice:

Sleep
Appetite/Eating
Relationships
Work/School
Alcohol or substance use

What do you hope to achieve through therapy?

The answer should be a text input.

10.

Is there anything you would like your therapist to know about you or your background?

The answer should be a text input.

11.

Are there any preferences or concerns regarding the therapy process?

The answer should be a text input.

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FAQs on Psychotherapy Intake Form

: It gathers key client information—such as mental health history, current symptoms, and treatment goals—to help therapists assess needs and prepare for the first session.
: Yes. All responses are kept strictly confidential and protected under privacy laws like HIPAA. Only your licensed therapist or clinical team will access this data.
: No, the intake form is only required before your first session. Therapists may request updates if your circumstances or symptoms change.

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