Counselling intake form: a free template for therapists

An intake form for counselling has a harder job than most. It has to collect enough for you to prepare, from someone who may be finding it difficult even to book. It shouldn’t feel like an assessment they can fail, and it has to set out the terms of the work before the first session starts.

This template is written for counsellors, psychotherapists and other talking therapists in UK private practice who work with adult clients. It has 16 questions in five sections, and 11 of them can be skipped. A client can get through it on a phone in about five minutes. Copy it, change it to fit how you work, and use it however you take bookings.

Read this before you copy anything

This template is a writing aid, not an assessment tool. What you ask, and how you respond to the answers, depends on your training and modality, your professional body’s ethical framework, your supervisor’s view and what your indemnity insurer expects you to have on record.

So treat every question below as a prompt. Delete what you would never use, add what your way of working needs, and talk the finished form through with your supervisor before a client sees it.

How the form is laid out

The order matters. The client should know the limits of confidentiality before they write anything, so Section 2 names all three in one sentence. The full agreement comes last, where the client signs it, and it is also the part most worth going over again, out loud, in the first session.

The template

Square brackets mark the parts only you can fill in.

Section 1: If you need help now

I read these answers before our first session, not as they arrive. If you are in crisis or feel unable to keep yourself safe, please don’t wait for our appointment. If your life is at risk now, call 999 or go to A&E. You can call Samaritans free on 116 123 at any time, day or night, or call NHS 111 and choose the mental health option.

This section has no questions, and that’s deliberate. It is the most important thing on the form. A booking form feels like a conversation, and someone in distress may write something on it that they expect a reply to tonight. Telling them plainly that nobody is reading it in real time, and where to go instead, is the honest thing to do, and it protects you as well. Giving it a section of its own, first, means it has a heading and can’t be skimmed past on the way to the questions.

If a client ever fills the form in with you, in the session, say the crisis notice out loud instead: it’s written for someone answering alone.

NHS 111 has a mental health option in Scotland and Wales too. Northern Ireland has no 111 line, so if you work there, give Lifeline instead: free on 0808 808 8000, at any time.

Section 2: Before we start

These questions help me prepare for our first session. Answer as much or as little as you’re comfortable with. Anything you’d rather talk about in person can wait until we meet.

What you write here is confidential, with the limits set out at the end of this form: I may need to share it if I believe you or someone else is at serious risk of harm, if a child or an adult at risk may be in danger, or if the law requires it.

1. Are you 18 or over? (Yes / No)
2. Have you had counselling or therapy before? (Yes / No)
3. If yes, what did you find helpful, or unhelpful? (free text)

Question 1 is there because work with under-18s brings its own consent questions, which this form doesn’t try to cover. If you see young people, they need a form of their own.

Section 3: What brings you here

There’s no right way to answer these, and you don’t need to explain anything in writing. We’ll talk it through when we meet.

4. What would you like to talk about? (choose any that apply: Anxiety or stress / Low mood / Relationships / Bereavement or loss / Work / Something that happened to me / Something else)
5. Is there anything you’d like to add? (free text)
6. Are you getting any other support for your mental health at the moment? (choose any that apply: My GP / NHS Talking Therapies / A psychiatrist or community mental health team / Another counsellor or therapist / Something else)
7. Are you taking any medication for your mental health? (choose one: Yes / No / I’d rather talk about this when we meet)
8. In the last few weeks, have you had thoughts of ending your life or harming yourself? (choose one: No / Yes / I’d rather talk about this when we meet)

A few notes on why these are worded the way they are:

• Ticks, not paragraphs. Most people would rather explain what brings them to counselling in person than type it into a form. A short list takes a few taps and still gives you something to prepare with. The free-text box is there for anyone who does want to say more, and a client who would rather say nothing yet can leave both blank. Goals are better worked out together in the first session than asked for up front.
• “I’d rather talk about this when we meet” is a real answer. It tells you something without forcing a disclosure the client isn’t ready to make in writing. It is also more truthful than a reluctant “No”.
• Ask about other support so you can coordinate, not to screen anyone out. Someone already working with a therapist elsewhere is a conversation to have in the first session, not an automatic refusal.

Question 8 is optional, and you should decide deliberately whether to keep it. Worrying that the question itself will put the idea in someone’s head isn’t a reason to drop it: research has found that asking about suicide does not increase suicidal thoughts, and may slightly reduce them. The real question is what happens to the answer, and there’s a good case on both sides:

• Keep it if you will read every form before the first session and you have a plan for a “Yes” that arrives a week ahead: a phone call, a check of your GP details, a word with your supervisor. A form that asks about risk and then goes unread for a week is worse than a form that doesn’t ask.
• Leave it out if you would rather assess risk in the room, where you can ask follow-up questions and see how the client is. Many experienced counsellors do. The crisis section stays either way.

Section 4: Practical things

These help with arrangements. None of them affect whether we can work together.

9. Your GP’s name and surgery (free text)
10. How would you prefer to meet? (choose one: In person / Video call / Phone / No preference)
11. Is there anything that would make our sessions easier for you, such as access needs, the times you can make, or the name and pronouns you’d like me to use? (free text)
12. How did you hear about me? (free text)

Ask for GP details only if your agreement says when you would use them, which is usually the serious-risk exception in Section 5. The same goes for an emergency contact. If you collect one, your agreement should say in what circumstances you would get in touch with them. If it doesn’t, leave the field out. Information you never use is still information you have to protect.

Drop question 10 if you work in only one way.

Section 5: Our agreement

Confidentiality. What you tell me stays between us, with a few exceptions I’m required to tell you about before we begin. I may need to share information without your agreement if I believe you or someone else is at serious risk of harm, if a child or an adult at risk may be in danger, or if the law requires it. Wherever I can, I will talk to you first. If you or someone else is at serious risk, I may contact your GP.

Supervision. Like all counsellors in my professional body, I discuss my work regularly with a clinical supervisor. I don’t share your name or anything that would identify you.

Notes. I keep brief notes of our sessions, stored securely. I keep them for [number] years after we finish working together, then delete them. You can ask to see what I hold about you.

Sessions and fees. Sessions last [50] minutes and cost [£fee]. If you cancel with less than [48 hours’] notice, the full fee is payable. Either of us can end our work together at any time, and I would ask that we have a final session to close it properly.

13. I have read how confidentiality works, including its limits. (consent checkbox)
14. I have read the information about notes, fees and cancellations. (consent checkbox)
15. I agree to begin counselling on these terms. (consent checkbox)
16. Signature (type your full name)

Three checkboxes rather than one might look like overkill. They aren’t. A single “I agree to everything above” gets ticked without being read. A separate box for the limits of confidentiality is the one you’ll be glad of if you ever have to act on them.

If your professional body or insurer publishes model wording for any of this, especially the confidentiality exceptions, their wording wins.

One thing this form is not: your privacy notice

Agreeing to counselling is not the same as agreeing to you holding their information. Don’t ask clients to “consent” to data processing on this form.

What you hold about a client is health information, and for most counsellors the lawful basis for keeping it isn’t consent at all. One tickbox that tries to cover both muddles both. Link your privacy notice from your booking page instead. Our post on whether counsellors need to register with the ICO covers the fee, the privacy notice and the rest of the short list.

Four habits that make it work

• Send it before the first session, not on the day. A form filled in on the doorstep is rushed, and it gives you no time to read it.
• Read every form before the session. If something worries you, act on it then rather than in the first five minutes of the hour.
• Go through the agreement out loud in session one. The form records what the client read. Talking it through is what makes it informed, and it’s the moment to answer questions about confidentiality.
• Review the form every year with your supervisor, and whenever your professional body updates its framework. Date the version you’re using.

How it maps onto Praxbook

Praxbook is a booking system for practitioners who work on their own. Each service can have its own consent form, which is what Praxbook calls a form like this one. That means the intake form needs two services. Create one for first sessions with this form attached, and one for ongoing sessions with no form, so returning clients aren’t asked again. Clients choose the service when they book, and each service’s description appears next to its name. Something like “For your first appointment” and “For clients I’m already seeing” does the sorting, because nothing stops a new client picking the ongoing one.

Skip the typing: Download the counselling intake form (CSV) and import it in Praxbook under Consent forms, Import a consent form. It brings all 16 questions and five sections across, with the agreement text already on the consent boxes. Fill in the square brackets, check it with your supervisor, then attach it to your first-session service.

If you’d rather build it by hand, the template maps onto the form builder directly:

A consent checkbox can show text above the box, and that text is saved with the tick. Put the agreement there rather than in the Section 5 heading’s paragraph: the Confidentiality and Supervision paragraphs above Q13, Notes and Sessions and fees above Q14. Each tick is then stored next to the exact words it agreed to.

You don’t need to ask for name, email or phone number, because the booking page already does. Keep Q5, though. The booking page has an optional box of its own for anything else, but a client you book in by phone, or who completes the form later, never sees it, and Q5 is the only free-text box Section 3 has.

Questions start out required. Keep Required on Q1, the three consent boxes and the signature, and untick it on everything else. A “No” to Q1 doesn’t stop the booking, so check it when you read the form. Turning on Ask patients for their date of birth, in your practice settings, asks for a date of birth as well, on the booking page and when you add a new client yourself.

Section paragraphs are plain text, so the bold in the template doesn’t carry over. That’s why the crisis notice is a section of its own: its heading gives it the emphasis that bold can’t.

In Praxbook the form comes after the client has chosen a time and given their details, so the crisis section opens the form rather than the booking. Put a line in the first-session service’s description too, which clients see on the first page: “If you need help urgently, don’t wait for an appointment: call 999, or Samaritans free on 116 123.”

Clients complete the form as part of booking online, before the timeslot is reserved. If you book someone in by phone and have Email patients about their bookings switched on, their confirmation email includes a link to complete it from their own account, and so does the reminder if you send reminders. If they arrive without having done it, the appointment page has Complete consent form now, which opens the form on your device for them to fill in. Each submission is kept on the appointment with the exact wording the client saw, including the confidentiality text, so changing next year’s agreement never rewrites what last year’s clients agreed to.

Try Praxbook free for 30 days, or share this template with a colleague who might find it useful.