MAKE YOUR FREE Intake Form
What is an Intake Form?
An Intake Form is a type of questionnaire used to gather information about a new client or patient. It can be used to kick off your first session and help you direct the conversation. Simple for the client or the service provider to fill out, this customizable Intake Form from Rocket Lawyer can be completed online within minutes. The questions will vary depending on the type of services being provided. From medical intake forms to intake forms for lawyers and counselors, this flexible online template can adapt to a number of scenarios.
Sample Intake Form
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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
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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.
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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
