New Client Intake/Assessment Form
A good intake and assessment form is vital for the smooth running of your private practice and where used correctly, will contribute to your new client retention rate.
Q: Why should I bother paying for a template, when there's so much free stuff available online?
A: Unless you're 100% certain of a template's origin/provenance, have purchased usage rights or it has a Creative Commons licence, you're at risked of being slapped with a "cease & desist" notice, or worse, sued for breach of copyright.
Starting at just £3 for unlimited use of a document that you will probably use hundreds of times in the course of your career, isn't that tiny layout worth it for peace of mind?
This questionnaire was designed and has been used by a practising psychotherapist hundreds of times in the course of three decades, so we know that it delivers on all fronts! Its focus is on obtaining key information to enable an initial consultation and assessment to be conducted within private practice.
While applicable for use internationally, the form is particularly suitable for use in a British context and reflects local concerns and protocol issues e.g G.P & emergency contact details, use of personal pronouns etc.
• 5 pages, with 31 questions, both required and optional.
• 4 files included in purchase price: 2 colourways (grey & orange highlights) in 2 file formats (PDF & Word) for flexible use.
• Files are editable in either file format – use Word, Adobe Acrobat or Canva to make any changes you require.
• Validation of required questions (when used in Acrobat).
• Multi-line and scrolling for longer responses.
• British English spelling and UK context
• A4 page sizing for printing
• Accessible – Add the form to a website, send it via email or print out for manual completion.
• Works on all devices and systems, including Windows, Mac OS, IOS, Android & Chromebook.
Subject Areas Covered:
• Contact Details, including G.P & emergency contact
• General Information & Profile History
• Medical History, including prescribed medicines, physical, psychiatric and psychological history
• Food, Alcohol & Recreational Substance Use
• Family & Relationship History
• Goals for Psychotherapy/Counselling
• Administrative Information
Refunds and returns are not available for digital goods, but please feel free to contact us if you have any questions or issues.
Please note that while you may print and use these files as many times as you like in pursuance of your work with clients/patients, you may not share, resell, reproduce, distribute electronically or physically, or in any way profit, whether directly or indirectly from these designs which are copyrighted.
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New Client Contract
Easy-to-edit Word document file - convert to PDF or print for signing.