Mental Health Intake Forms & Client Questionnaires

Mental health intake is not the same as general medical intake. A therapist seeing a new client needs to know presenting concerns, prior treatment history, current medications, family psychiatric history, substance use, and safety risk factors — and that information has to be gathered with enough sensitivity that the client actually fills it out honestly. These forms are built specifically for mental health and behavioral health practices, with HIPAA-styled footers on every page.

Three Forms for Three Different Practices

A therapy practice, a psychiatry practice, and a health coaching practice all deal with mental and emotional health, but their intake needs are meaningfully different.

The Mental Health Therapy form is the most comprehensive. It captures presenting concern, symptom duration, prior therapy and counseling history, current and past medications, psychiatric hospitalizations, trauma history, substance use screening, suicidal ideation assessment, emergency contacts, and treatment goals. The intake side is what the clinician fills out during the initial session. The client questionnaire is what the client completes beforehand — their own description of what brought them in, what they have tried, and what they hope to get out of treatment.

The Psychiatry form adds medication management sections that the therapy form does not need: current prescriptions with dosages and prescribing providers, medication allergies and adverse reactions, prior medication trials and reasons for discontinuation, and a review of systems. If your practice prescribes, this is the form you want.

The Health Coaching form is lighter. Health coaches typically do not diagnose or prescribe, so this form focuses on lifestyle factors: nutrition, exercise, sleep, stress levels, health goals, motivation and readiness for change, and any medical conditions the coach should be aware of. It still carries the HIPAA-styled footer because coaches often work alongside clinical providers.

What the Office Intake Covers

The intake form is the internal clinical document. It captures demographics, insurance verification, referral source, presenting complaint, medical and psychiatric history, medications, allergies, family history, and provider notes. Each specialty adds its own clinical fields on top of that foundation. The therapist version includes risk assessment checkboxes. The psychiatry version includes a medication reconciliation section. The coaching version includes readiness and motivation scales.

What the Client Questionnaire Covers

The questionnaire is what the client fills out. It walks them through describing their concerns, listing current medications and supplements, noting any prior therapy or psychiatric treatment, identifying their emergency contact, and signing the HIPAA acknowledgment and consent to treatment. For therapy and psychiatry, it includes standardized screening questions about mood, anxiety, sleep, appetite, and concentration.

Related Guides

Mental Health Counseling Intake Form Guide · Therapy Intake Forms: What to Include · Intake Forms for Mental Health Therapists & Counselors · Psychiatry Intake Form Guide · Health Coaching Intake Form Guide

Individual forms are $19.99 for the complete set (intake + questionnaire), $14.99 for intake only, or $9.99 for questionnaire only.

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