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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: |
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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.
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:
