Counseling Intake Form

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A counseling intake form collects information about a potential client before their first counseling session. This document allows the counselor to become familiar with their client to create a productive initial consultation. The client is asked to enter their personal and family information, physical and mental health, and past and present issues they need help with.

Counseling Intake Form

A counseling intake form collects information about a potential client before their first counseling session. This document allows the counselor to become familiar with their client to create a productive initial consultation. The client is asked to enter their personal and family information, physical and mental health, and past and present issues they need help with.

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Last updated September 30th, 2024

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A counseling intake form collects information about a potential client before their first counseling session. This document allows the counselor to become familiar with their client to create a productive initial consultation. The client is asked to enter their personal and family information, physical and mental health, and past and present issues they need help with.

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Confidentiality

A counselor is obligated to maintain client confidentiality regarding any personal or medical information shared through an intake form.

There are a number of exceptions established by the HIPAA Privacy Rule that allow the disclosure of information without consent (e.g., being a threat to themselves or others, child abuse/neglect, criminal investigations).[1]

Important Sections

Personal Information

The form should ask for the client’s name, address, contact info, emergency contact info, date of birth, educational background, religious beliefs, relationship status, and current employment situation.

Medical History

A client’s medical history is an essential part of the form as it allows the counselor to assess the client’s current physical and mental state before the first session. Furthermore, if the client is using medication, the counselor may need to adjust the treatment options to avoid contraindications.

Alcohol & Drug Use

Understanding the severity of a client’s substance abuse will help the counselor determine what sort of care and treatment the client will need. While a counselor isn’t trained to treat the client medically, it’s helpful to have a full understanding of their current state.

Personal Issues

The counselor should be aware of the client’s main issues and concerns, which will make the initial counseling sessions more productive and likely to result in the most appropriate solution or treatment.

Family Concerns

Any family concerns the client has, such as death, divorce, abuse, financial problems, etc., should be provided on the form to give the counselor the full picture of the client’s life and their issues.

Counseling Client Intake Form (Preview)