Psychology Intake Forms & Client Questionnaires

The first session with a new therapy client is not really a session — it is an assessment. You are simultaneously building rapport, screening for risk, establishing diagnostic hypotheses, and determining whether your practice is the right fit for this person’s needs. A generic health history form asks about surgeries and allergies. It does not ask about prior psychiatric hospitalizations, current suicidal ideation with plan and means, history of self-harm, trauma exposure, or whether the client has been court-ordered into treatment. These are not optional questions. They determine your clinical approach, your safety planning obligations, and in some cases whether you can ethically take this client at all.

The Psychology intake form captures the clinical information that shapes your treatment plan from the first hour. Presenting concerns with onset, duration, severity, and precipitating events. Current symptom profile across mood, anxiety, psychotic, dissociative, and somatic domains. Prior treatment history — not just “have you been in therapy before” but with whom, what modality (CBT, DBT, EMDR, psychodynamic, psychoanalytic), for how long, how it ended, and what the client found helpful or unhelpful. Medication history with prescriber, dosage, duration, effectiveness, side effects, and reason for discontinuation.

Diagnostic Screening and Risk Assessment

A psychology intake form needs to capture enough information for you to generate a working differential diagnosis without conducting a full structured clinical interview on paper. The form includes screening sections for depressive disorders, anxiety disorders, PTSD and trauma-related conditions, obsessive-compulsive spectrum, eating disorders, substance use disorders, personality disorder features, and psychotic symptoms. Each section uses targeted questions that map to DSM-5-TR diagnostic criteria without requiring the client to navigate clinical jargon.

Risk assessment is not a single question at the bottom of the form — it is its own section. The form captures current suicidal ideation (passive vs. active), history of suicide attempts (number, method, medical intervention required, recency), current self-harm behaviors, homicidal ideation, access to firearms or other lethal means, and protective factors. It documents whether the client has a current safety plan and identifies emergency contacts who are aware of the client’s mental health concerns. This section exists because the information needs to be in the chart before the first clinical conversation, not discovered mid-session when you have to shift gears from rapport-building to crisis assessment.

Developmental and Family History

Clinical psychology requires developmental context that no other healthcare specialty captures in the same way. The intake form includes a developmental history section covering prenatal and birth complications, developmental milestones, childhood temperament, attachment relationships, school performance, peer relationships, and significant childhood events including abuse, neglect, household instability, parental substance use, parental mental illness, and exposure to domestic violence. These are the ACEs (Adverse Childhood Experiences) questions, reframed for an adult clinical population.

Family psychiatric history goes beyond “any mental health problems in the family.” The form captures specific diagnoses in first-degree and second-degree relatives: mood disorders, anxiety disorders, psychotic disorders, substance use disorders, suicide, and neurodevelopmental conditions including ADHD and autism spectrum disorder. Family history of bipolar disorder, for instance, changes your prescribing considerations if you are a prescribing psychologist and alters your differential diagnosis if a client presents with depression that has not responded to standard treatment.

Substance Use and Functional Assessment

Substance use screening is integrated into the psychology intake because comorbidity rates are high and because substance use can both cause and mask psychiatric symptoms. The form captures current and past use of alcohol, cannabis, stimulants, opioids, benzodiazepines (prescribed and non-prescribed), hallucinogens, and nicotine. For each substance, it documents frequency, quantity, last use, longest period of sobriety, prior treatment (detox, inpatient, IOP, 12-step), and whether the client considers their use problematic. Screening questions are adapted from validated instruments without reproducing copyrighted scales.

Functional assessment captures how the client’s symptoms affect daily life across domains: occupational (work performance, absenteeism, disability status), academic, social (isolation, relationship conflict, support network), self-care (hygiene, nutrition, sleep), and legal (current involvement with the justice system, probation or parole, pending charges). Treatment goals are documented in the client’s own language — not clinical terminology — so the treatment plan reflects what the client actually wants to work on, not what the clinician assumes the treatment target should be.

Intake vs. Client Questionnaire

The intake form is your internal clinical document. You or your intake coordinator complete it during the initial assessment session, recording clinical observations, diagnostic impressions, and risk level determinations that require professional judgment. The companion client questionnaire is what you send to the client before their first appointment. It asks about their reasons for seeking treatment, prior therapy experience, current medications, family background, and insurance information in accessible language. It includes informed consent for treatment, HIPAA authorization, limits of confidentiality (including mandatory reporting obligations), cancellation policy acknowledgment, and teletherapy consent if applicable.

Pricing

Each form is $19.99 for the complete set (intake + questionnaire), $14.99 for intake only, or $9.99 for questionnaire only. All PDFs are fillable in Adobe Reader, password-protected against editing, and HIPAA-compliant.

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