New client intake form - Debbie Disney, LCSW-C 2025

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The document is a New Client Intake Form for Positive Changes Counseling Center, designed to collect confidential information from clients prior to their first therapy session. It includes sections for personal details, health and mental health history, family mental health background, and additional information relevant to the client's therapy goals and experiences.

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How to use or fill out new client intake form - Debbie Disney, LCSW-C

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields. Fill in your name, birth date, and gender accurately to ensure proper identification.
If applicable, provide details about your parent or guardian if you are under 18 years old. This section is crucial for minors.
Complete the insurance information section, including the policy holder's name and birth date. This helps facilitate billing and insurance claims.
Fill out your contact information, ensuring to indicate whether messages can be left on your home or cell phone.
Answer questions regarding your mental health history and current health status. Be honest and thorough as this information is vital for effective treatment.
In the family mental health history section, indicate any relevant conditions that may affect your care.
Finally, reflect on your goals for therapy and any additional information you wish to share. This will help tailor the therapeutic approach to your needs.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who fills out the client intake form?

A client intake form is a document professional service providers use to gather essential information from their clients at the beginning of their relationship. But why is it necessary for every client to fill out a client intake form? Simply, it ensures you consistently capture all pertinent details.

When should a client fill out an intake form?

How to create a sample intake form with Google Forms Step 1: Create a new Google Form. Navigate to your Google Forms. Step 2: Enter fields for personal information. Step 3: Collect necessary background information. Step 4: Ask how they heard about you. Step 5: Create a PDF intake form.

How do you write a client intake form?

Fundamental contact and company information. Start by asking your prospective client to fill out their basic information: company name, primary contact information, preferred contact method, role, company size, and industry, just to name a few.