Free download
Free counselling intake form template.
This counseling intake form template gives you a complete first-session form to send to a new client. It collects what you need before they arrive, so the session can start with the person and not with paperwork.
It works as a psychology intake form template or a psychologist intake questionnaire, and it was written as a counselling intake form for South Africa, with medical aid fields included. The questions follow the usual psychological intake interview questions: why now, what has happened before, and who else is involved.
Word (editable) and PDF, with a couples version · free · no sign-up needed
What’s inside
- Contact details and emergency contact
- Presenting concern, in the client’s own words
- Personal, family and medical history
- Medical aid scheme, plan, member and dependant details
- A separate couples version
Edit the questions to fit your scope of practice. History a client reports on a form is self-reported until you have confirmed it clinically.
Or skip the template
Let clients fill this in online before the first session
Clients complete and sign online, and their file creates itself with the signed PDF attached.
Guides that use this download
What to include in a counselling intake form (with a free template)
A counseling intake form example for South African practitioners: the sections to include, what to leave out, and a couples version. Free template.
Counselling consent form: what it must cover in South Africa
What a counselling consent form in South Africa should cover: confidentiality, fees, online sessions, POPIA and consent for minors. Free template.
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