make your free intake form
what is an intake form?
sample intake form
the terms in your document will update based on the information you provide
for
personal information
name:
date of birth:
address:
,
marital status:
gender identity:
phone number:
email address:
employer:
occupation:
emergency contact
name:
relationship:
phone number:
by: | date: |
intake form faqs
-
when should i use an intake form?
it is best to use an intake form at the very start of a new relationship with a client or patient. often it can even help you determine if and how you can meet their needs. great for record-keeping, this document can serve as a information sheet that you can continue to reference as needed throughout the duration of your relationship.
-
what is included in an intake form?
the details that are collected in an intake form vary based on the services that are being provided, but in general, you can expect to capture the following information:
- the client or patient's name
- contact information, such as address, phone number, and email
- general overview of why they are seeking your services
- insurance information, if applicable