Healthcare & Clinical · community shared

Mental Health Intake Form — shared by the community

Yusuf E. shared this 25-question build with 4 conditional rules already wired up. Test it below, then take a copy.

A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 25 questions, 3 pages, 4 conditional rules.

Shared by
Yusuf E. · Recruitment partner
Questions
25
Replies
25
Copies taken
886
See the library version

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Live preview and test console

This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.

Page 1 of 3What brings you here

In your own words

Include your country code.

Is it safe to leave a voicemail on this number?

Every question on this page is currently visible.

Works for you? Take Yusuf E.'s copy into your own workspace — questions, rules and settings included.

Who this template is for

Mental Health Intake Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.

  • Small teams who need a reliable intake process working in healthcare & clinical.
  • Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
  • Anyone replacing chasing missing details over email with one structured record per enquiry.
  • Respondents are the people you send it to — the form asks them 25 questions across 3 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.

  • 14 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It captures a phone number for urgent follow-up.
  • It pins the request to a specific date.
  • Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
  • Splitting the form across 3 pages keeps each screen short and shows respondents how much is left.
  • Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Mental Health Intake Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

  • Features conditional validation: if “Have you had support for this before?” is Yes, “What kind, and did it help?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Are you having thoughts of harming yourself at the moment?” is Yes, “Tell us what you are experiencing” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Do you use alcohol or drugs to cope?” is Yes, “What, and how often?” becomes mandatory before the form can be sent.
  • Features advanced show logic: if “Is anyone at home relying on you for care?” is Yes, the form dynamically exposes “Who relies on you?”. Otherwise that question never appears.
  • All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

What this form asks

Page 1 — What brings you here

  • Full namerequired
  • Date of birthrequired
  • Contact numberrequired
  • Is it safe to leave a voicemail on this number?required
  • What has brought you to the service now?required
  • How long has this been going on?required
  • What does a difficult day look like?
  • Has anything changed recently?

Page 2 — History and support

  • Have you had support for this before?required
  • What kind, and did it help?
  • Current medication
  • Physical health that affects how you feel
  • Who do you live with?required
  • Work, study or daily routine
  • Who can you talk to when things are hard?
  • Is anyone at home relying on you for care?required
  • Who relies on you?

Page 3 — Safety and goals

  • Are you having thoughts of harming yourself at the moment?required
  • Tell us what you are experiencing
  • Have you ever acted on those thoughts?required
  • Do you use alcohol or drugs to cope?required
  • What, and how often?
  • Is anyone else at risk of harm?required
  • What would you like to be different?required
  • Anything you would like us to know before we meet

Conditional logic in this build

  • WhenHave you had support for this before?is Yes, requireWhat kind, and did it help?”.
  • WhenAre you having thoughts of harming yourself at the moment?is Yes, requireTell us what you are experiencing”.
  • WhenDo you use alcohol or drugs to cope?is Yes, requireWhat, and how often?”.
  • WhenIs anyone at home relying on you for care?is Yes, showWho relies on you?”.

Questions about this shared form

How is this different from the Therapy Client Intake Form?

That one is a shorter counselling intake for private practice. This is the fuller service-level assessment, with the history, context and safety sections a multi-practitioner team needs.

Should the form triage or score answers?

No. It records what the person reports; every decision about urgency and suitability belongs with a practitioner reading the whole submission.

What if someone discloses immediate risk?

Your service needs a documented route for that before the form goes live, including who is notified and what happens outside working hours. Say those hours in the intro.

Can it be completed with a practitioner instead?

Yes. Some people would rather answer these questions aloud, and the same form works as a structured first-conversation record.

Is the Mental Health Intake Form template free to use?

Yes. You can preview and test Mental Health Intake Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Mental Health Intake Form template ask for?

It asks 25 questions across 3 pages, 14 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Mental Health Intake Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this healthcare & clinical form work?

4 conditional rules ship with the template: Features conditional validation: if “Have you had support for this before?” is Yes, “What kind, and did it help?” becomes mandatory before the form can be sent. Features conditional validation: if “Are you having thoughts of harming yourself at the moment?” is Yes, “Tell us what you are experiencing” becomes mandatory before the form can be sent. Features conditional validation: if “Do you use alcohol or drugs to cope?” is Yes, “What, and how often?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Mental Health Intake Form form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Mental Health Intake Form form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.