Bring on new clients or patients: 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.
Have questions about your Intake Form?
Whether you're preparing your Intake Form, reviewing one someone sent you, or just want to understand it better, here's how to get help.
- Understand what it says or review it. Use our AI legal assistant to ask questions about your Intake Form, understand what it says, and spot anything that may need a closer look.
- Ask an attorney a question. Connect with an attorney for legal information, with a written answer within one business day or a live consultation.
- Get advice on what to do. For privileged, confidential advice about your specific circumstances and next steps, book a Legal Advice Session with an attorney.
Sample Intake Form
The terms in your document will update based on the information you provide
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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
