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)
- Acupuncture
- Bookkeeping
- Business Consulting
- Cannabis Patient
- Chiropractic
- Contract Review
- Cosmetology
- Counseling
- Employee (Recruiter)
- Esthetician (Facial) – botox
- Event Planner – wedding
- Financial Planner
- Gym
- Health Coach – nutrition
- HR
- Hypnosis
- Law (Attorney)
- Life Coach
- Mental Health
- Massage (Spa)
- Patient (Medical)
- Personal Trainer
- Physical Therapy
- Project
- Psychiatrist
- Psychotherapy
- Recruiting
- Real Estate – Make this a parent with ‘Buyer’ and ‘Seller’ as sub-types
- Reflexology
- Salon
- Tax Preparer – Add IRS intake
- Therapist
- Veterinary
- Volunteer
- Website – design, development
- 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: ____________________