Intake and consent forms
What to include in a counselling intake form (with a free template)
A good intake form means the first session starts with the person and not with a clipboard. This guide walks through a counseling intake form example section by section, so you can build your own or adapt the free template below.
It is written for counsellors and psychologists in South African private practice, which is why it includes medical aid details that overseas examples leave out.
3 October 2026 · 6 min read
What an intake form is for
An intake form does three jobs. It collects the practical details you need to open a client file. It gives you a first picture of why the client is coming. And it tells you about risk before the client is sitting in front of you.
It is not a consent form. Consent covers what the client agrees to, and it needs its own document and signature. Our guide to the counselling consent form in South Africa covers that side.
The sections every intake form needs
| Section | What to ask | Why it matters |
|---|---|---|
| Identity and contact | Full name, ID number, date of birth, phone, email, address | Opens the client file and tells you how to reach them |
| Emergency contact | Name, relationship and phone number | You need this before a crisis, not during one |
| Presenting concern | What brings you here, and why now? | The client’s own words are the best starting point |
| History | Previous counselling, diagnoses, medication, medical conditions | Context for the first session, to be confirmed clinically |
| Risk | Thoughts of self-harm or suicide, and current safety | Tells you whether the first session needs a different focus |
| Medical aid | Scheme, plan, member number, main member and dependant code | Without these the invoice can’t be claimed |
| Referral source | Where did you hear about us? | Shows you which referral sources send clients |
Keep the open questions short. A client who has to write an essay before a first session often doesn’t finish the form.
A counseling intake form example, question by question
Here is how the presenting-concern section might read on a real form. The wording is plain on purpose.
Example: presenting concern
- What brings you to counselling?
- A few lines in your own words is enough.
- How long has this been a concern?
- Less than a month / 1 to 6 months / More than 6 months
- What would you like to be different?
- One or two things you hope will change.
- Have you had counselling or therapy before?
- Yes / No. If yes, was it helpful?
- Are you taking any medication?
- Name and dose, if you know it.
Treat everything in the history section as self-reported. A client may write “bipolar” because a relative said so once. Record it as what the client told you until you have confirmed it yourself.
Couples, marriage and premarital intake forms
A couples counseling intake form should not be one form filled in by both partners at the kitchen table. Each partner needs their own copy, completed privately. People write differently when their partner isn’t reading over their shoulder, and risk questions in particular must be answered alone.
A marriage counseling intake form adds a few questions to the individual version:
- How long have you been together, and are you married, engaged or living together?
- What does each of you see as the main difficulty?
- What is going well in the relationship?
- Do you feel safe at home?
- Have you had couples counselling before?
A premarital counseling intake form is lighter. It asks about expectations (finances, children, family, faith) more than about problems. If you are looking for a premarital counseling intake form PDF, the couples version in the free template can be trimmed down to these questions.
What to leave off the form
- Long symptom checklists. Use a proper screening tool in session if you need one.
- Questions you never read. If the answer doesn’t change what you do, cut the question.
- Clinical language. Ask “Have you felt unsafe?” and not “Any history of trauma exposure?”
- Consent wording. Keep it in the consent form so the client signs for it clearly.
Only collect what you need. Under the Protection of Personal Information Act (POPIA), personal information should be adequate, relevant and not excessive for its purpose, and health information gets extra protection.
When to send it
Send the intake form as soon as the client books. A form completed the night before gives you time to read it. A form completed in your waiting room costs ten minutes of the session.
If you take bookings online, the form can go out without you. In Wholistic, a new client who books through your online booking page gets the form immediately, and automatic reminders follow if it isn’t signed.
Common questions
Is an intake form the same as a consent form?
No. The intake form collects information about the client. The consent form records what the client agrees to: confidentiality and its limits, fees, cancellations and how their information is kept. You need both.
Should a couple fill in one form or two?
Two. Each partner completes their own form privately. You get a more honest picture, and safety questions can be answered without the other partner seeing them.
How long should an intake form be?
Short enough to finish in ten minutes. Two pages is a sensible limit for an individual. Anything more detailed belongs in the first session.
In Wholistic
Send this intake form automatically when a new client books. Wholistic does it for you.
Clients complete and sign online, and their file creates itself with the signed PDF attached.
See intake and consent forms