Therapy Intake template

A therapy intake form written for the moment before a first session, when filling out a form is itself a hurdle. Nearly everything is optional, the reasons-for-coming checklist includes "I'd rather share in session," and a 1–10 stress rating gives the practice a starting signal — enough to match the client with the right therapist without asking anyone to over-disclose.

Use this template Start free — no card

8 questions · works on the free plan (500 responses/month) · fully customizable

What’s inside

The questions this template ships with — rename, reorder, or delete any of them in the builder.

01Your contact detailsContact info

02Have you worked with a therapist before?Multiple choice

03What's bringing you in right now?Checkboxes

04How would you rate your stress level lately?Rating scale

05How would you prefer to meet?Multiple choice

06What would you like to get out of therapy?Long text

When to use this template

A group practice matching new clients to therapists based on what's bringing them in and how they prefer to meet
A solo therapist replacing an email back-and-forth with a form that new clients can complete in their own time
A counseling center triaging a waitlist, using the stress rating and reasons checklist to prioritize outreach
An EAP provider collecting first-contact information that stays deliberately light

Tips to get more from it

The reasons checklist displays as a two-column grid, allows Other, and includes "I'd rather share in session" — that escape hatch is the most important option on the form, so keep it if you edit the list
Only contact details and the meeting-format question are required; the template leans on optional questions by design, and tightening that tends to cost completions
The in-person, video, or open-to-either question tells you which therapists are even eligible for the match before anyone reviews the rest
The ending promises outreach within 2 business days — edit that number to a promise your team actually keeps

Questions people ask

What should a therapy intake form ask?

This template keeps first contact light: contact details, prior therapy experience, an optional checklist of what's bringing the person in, a stress rating, meeting preference, and goals. Deeper history is left for the sessions themselves.

Do clients have to answer every question?

No. Most questions are optional, the checklist includes "I'd rather share in session," and the welcome text says outright to share only what feels comfortable.

Can I edit the wording to match my practice's voice?

Yes — every question, description, and the welcome and ending screens are editable, so you can adjust the tone while keeping the structure and the two-column checklist layout.