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Client Intake Forms (36)

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Updated on May 30th, 2023

An intake form gathers essential information about a client, including their contact details and the requested services. Its main purpose is to obtain the client’s information and their needs prior to the first meeting.

By Type (36)

  1. Acupuncture
  2. Bookkeeping
  3. Business Consulting
  4. Cannabis Patient
  5. Chiropractic
  6. Contract Review
  7. Cosmetology
  8. Counseling
  9. Employee (Recruiter)
  10. Esthetician (Facial) – botox
  11. Event Planner – wedding
  12. Financial Planner
  13. Gym
  14. Health Coach – nutrition
  15. HR
  16. Hypnosis
  17. Law (Attorney)
  18. Life Coach
  19. Mental Health
  20. Massage (Spa)
  21. Patient (Medical)
  22. Personal Trainer
  23. Physical Therapy
  24. Project
  25. Psychiatrist
  26. Psychotherapy
  27. Recruiting
  28. Real Estate – Make this a parent with ‘Buyer’ and ‘Seller’ as sub-types
  29. Reflexology
  30. Salon
  31. Tax Preparer – Add IRS intake
  32. Therapist
  33. Veterinary
  34. Volunteer
  35. Website – design, development
  36. Yoga

Sample

CLIENT INTAKE FORM

DISCLAIMER: Thank you for your interest in being a client of [ORGANIZATION’S NAME]. This form is used to collect information about new clients for internal purposes only and to be kept confidential.

PERSONAL INFORMATION

Name: ____________________ Gender: ☐ Male ☐ Female ☐ Other
Street Address: ________________________________________
City: ____________________ State: ____________________ Zip Code: ________
E-Mail: ____________________ Phone: ____________________
Date of Birth: ____/____/____ Ethnicity/Race: ____________________
Education: ☐ GED ☐ High School ☐ Bachelor’s ☐ Master’s

SERVICE REQUEST

What is the reason for seeking our services?

How did you hear about us? ________________________________________

SIGNATURE

Signature: _____________________________ Date: ____________________