Templates · Free template · Mental health
Counselling and Therapy Intake Form Template
A printable intake form for counsellors and therapists to collect presenting concerns, history, supports, and safety information before a first session.
Gather enough, not everything
An intake form should give you a starting point, not a life story. Ask what brings the client in, what has helped, who supports them, and any safety concerns, and leave the deeper history for the session.
Include a safety question and an emergency contact, and explain what confidentiality does and does not cover. Clients should not be surprised later by the limits of confidentiality.
Counselling and Therapy Intake Form
Client
Presenting concerns
Background
Safety
Emergency contact
Signatures
Template from zdrovia.ca/templates/counselling-intake-form/ · Review with your medical director, regulatory college guidance, and insurer before use.
Send this form before the appointment instead of printing it
Zdrovia's form builder turns this template into a digital form your clients sign on their own phone. The signed copy files into their chart with the exact version they saw, and photo consent stays separate from treatment consent. It's free for solo practitioners, with data stored in Canada.
See how Zdrovia is set up for therapy practices.
Frequently asked questions
Should intake include a screening tool?
Some clinics add a PHQ-9 or GAD-7. Note that a screening score is not a diagnosis.
How is this different from informed consent?
Intake gathers information. Consent to therapy explains the process, confidentiality, and policies.
Related
This template is a starting point for discussion with your team and advisors, not legal or medical advice. Requirements vary by province and profession. Have your medical director, your regulatory college's guidance, and your malpractice insurer confirm the wording before you use it with patients.