Counseling Intake Form
A counseling and therapy intake capturing contact details, what brings the client in, and preferences.
- Reason for support
- Session preference
- Responsive
- No dependencies
Fields included
- Name
- Phone
- What brings you in
- Preference
Works great with
How to Use This Template
- 1Sign up for a free Static Forms account to get your API key.
- 2Copy the HTML code above and save it as an
.htmlfile. - 3Replace
YOUR_API_KEYwith your actual API key. - 4Deploy the file to your website and start receiving submissions in your inbox.
Frequently asked questions
Can I collect sensitive mental health details here?
No. This is a general intake template, not a HIPAA-compliant or clinical records system. Keep this to basic contact and scheduling context, and collect sensitive history through a compliant, secure platform.
What is appropriate to ask on this form?
Contact details, a brief note on what the client is seeking support with, and session preferences (in person or virtual). Save detailed clinical intake for a secure system.
Can clients request virtual sessions?
Yes. The preference field lets clients choose in-person or virtual so you can plan the first session accordingly.
How do I follow up confidentially?
Reply from a secure, professional email and move detailed intake into your compliant practice-management system as soon as possible.
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Start receiving form submissions today
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