Wellness · free template

Therapy Intake Form

New client intake for a therapy practice covering contact details, presenting concerns and session preferences.

A ready-to-use fitness, wellness & coaching form for clinics, coaches and therapists: 15 questions, 3 pages, 3 conditional rules.

Questions: 15
Pages: 3
Layouts: classic · card
Conditional rules: 3
Typical time: 6 min

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Live preview and test console

This is the real form. Answer it to test the 3 conditional rules — nothing is sent or stored.

Page 1 of 3 — About you

2 questions are hidden by conditional logic right now — change an answer above to reveal them.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

Therapy Intake Form is built for clinics, coaches and therapists who need to collect intake detail and consent before the first session.

Clinics, coaches and therapists working in fitness, wellness & coaching.
Teams who need to collect intake detail and consent before the first session without writing code or paying for a custom build.
Anyone replacing paperwork eating the start of every appointment with one structured record per enquiry.
Respondents are clients and patients — the form asks them 15 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 paperwork eating the start of every appointment and turns each submission into a record your team can act on immediately.

7 questions are required, so submissions arrive complete instead of needing a follow-up email.
It collects a verified email address so replies and confirmations land.
It captures a phone number for urgent follow-up.
It records a signature you can keep as proof of agreement.
It pins the request to a specific date.
It allows multiple selections without free text.
Conditional logic hides 3 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.

How to use this template

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

1Press “Use this template” — a fresh copy of Therapy Intake Form lands in your workspace, ready to edit.
2Rename or delete any question, and change what is required. Nothing here is fixed.
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.
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.
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 — 3 conditional rules ship with it.

Features advanced show logic: if “Have you been in therapy before?” is Yes, the form dynamically exposes “What worked well or didn't work in previous therapy?”. Otherwise that question never appears.
Features advanced show logic: if “Have you been in therapy before?” is No, this is my first time, the form dynamically exposes “What do you hope sessions will help with?”. Otherwise that question never appears.
Features advanced show logic: if “Preferred session format” is Video sessions, the form dynamically exposes “Have you used video calls for appointments before?”. Otherwise that question never appears.
All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

A therapist's first-session paperwork needs to gather enough context to make the initial conversation useful without turning into a clinical assessment before the client has even met their provider. This form opens with contact and scheduling preferences, then moves into what brought the client in — a short open field for the presenting concern, plus a checklist of areas they might want to work on so nothing gets missed if they're unsure how to phrase it. A previous-therapy question lets the intake branch: someone who has been in therapy before is asked what worked and what didn't, while a first-timer is asked instead what they hope sessions will look like. Session-format and scheduling preferences come next, useful whether the practice offers in-person, video or both. The final section covers emergency contact information and a general consent-to-treatment acknowledgement, written as a plain statement rather than clinical language, with a clear note that it does not stand in for a signed informed-consent form the practice's own clinician should provide. It complements, rather than replaces, a wellbeing screening if the practice also uses one.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — About you

Full namerequired
Email addressrequired
Phone number
Date of birth
Have you been in therapy before?required
What worked well or didn't work in previous therapy?
What do you hope sessions will help with?

Page 2 — What brings you in

Briefly, what brings you to therapy right now?required
Areas you'd like to work on
Preferred session format
Have you used video calls for appointments before?
When are you generally available?

Page 3 — Contacts & consent

Emergency contact name and phone numberrequired
Agreementrequired
Client or guardian signaturerequired

15 questions in total.

How the form changes as it's filled in

This template ships with 3 conditional rules, grouped into 3 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Have you been in therapy before?”

Reveals questions
If “Have you been in therapy before?” is Yes, the form reveals “What worked well or didn't work in previous therapy?”.
Reveals questions
If “Have you been in therapy before?” is No, this is my first time, the form reveals “What do you hope sessions will help with?”.

Driven by “Preferred session format”

Reveals questions
If “Preferred session format” is Video sessions, the form reveals “Have you used video calls for appointments before?”.

Set it up step by step

1
Let the open field do the heavy lifting
Keep the presenting-concern question short and unstructured — the checklist below it exists to jog memory, not to replace the client's own words.
2
Branch on prior therapy experience
Someone returning to therapy and a first-timer need different follow-up questions; the logic above keeps each person's next question relevant.
3
Pair with a screening tool if your practice uses one
This intake is about context and logistics — use the Wellbeing Screening Form separately for any structured self-report measure your practice relies on.
4
Keep the consent line general
This form is not a substitute for your practice's own signed informed-consent document; have that reviewed and provided separately.

Mistakes to avoid

Making the presenting-concern field a rigid multiple-choice list instead of leaving room for the client's own description.
Skipping the emergency contact field, which the practice may need for duty-of-care reasons.
Treating this intake as a diagnostic tool rather than background for the first conversation.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Review submissions before the first session so the client doesn't have to repeat their story, and confirm session logistics by email or phone ahead of time.

Works in both layouts

Browse classic templates Browse card templates

Forms that overlap this one

These pages cover the same subject ground as the therapy intake form, matched on the words people actually search for.

Privacy & compliance

This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.

Frequently asked questions

Is this a clinical assessment?

No. It gathers background and preferences ahead of a first session; any clinical assessment or diagnosis should come from the therapist directly, and this form makes no medical claims.

How does this relate to the Wellbeing Screening Form?

The Wellbeing Screening Form is a shorter, standalone check-in some practices use before booking; this Therapy Intake Form is the fuller onboarding paperwork completed once a session is scheduled.

Can I use this for couples or family therapy?

You'll want to duplicate the contact and background section per person — this version is written for an individual client's first intake.

Do I still need a signed consent-to-treatment form?

Yes — this intake's consent line is a general acknowledgement only. Have your own reviewed informed-consent document ready for the client to sign separately.

Is the Therapy Intake Form template free to use?

Yes. You can preview and test Therapy 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 Therapy Intake Form template ask for?

It asks 15 questions across 3 pages, 7 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 Therapy 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 fitness, wellness & coaching form work?

3 conditional rules ship with the template: Features advanced show logic: if “Have you been in therapy before?” is Yes, the form dynamically exposes “What worked well or didn't work in previous therapy?”. Otherwise that question never appears. Features advanced show logic: if “Have you been in therapy before?” is No, this is my first time, the form dynamically exposes “What do you hope sessions will help with?”. Otherwise that question never appears. Features advanced show logic: if “Preferred session format” is Video sessions, the form dynamically exposes “Have you used video calls for appointments before?”. Otherwise that question never appears. All rules are editable in the Logic tab.

Where do responses to the Therapy 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 Therapy 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.

Is the signature on this form legally usable?

The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.

More forms teams pair with the therapy intake form.

Related categories

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