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Counseling Intake Form

Professional counselors need to be able to gather important information from their clients in order to provide the best possible care. This intake form template is designed to help counselors do just that. The form can be customized for your needs and easily shared with clients.

What exactly is a counseling intake form?

A counseling intake form is a document that collects basic information about a client, such as a name, contact information, and any mental health concerns. This information can help counselors to provide optimal care for their clients. The form can also be used to collect other important information, such as insurance information and payment preferences.

Some questions you can ask in a counseling intake form provides many useful form fields that will get you data in the best possible way. For example, you can use the opinion scale to see how people feel about something, text fields to get detailed explanations, or choice fields to give your clients pre-given choices to choose from.

  • What brought you to counseling?
  • Have you ever received counseling or therapy before?
  • What are your current mental health concerns?
  • Do you have any chronic mental health conditions?
  • What is your current stress level?
  • What is your current emotional state?
  • Are you suicidal or have thoughts of harming yourself?
  • What is your current relationship status?
  • Do you have any children?
  • Do you have a job?
  • How would you like to be contacted?
  • What is the best time to reach you?
  • Do you have any preferences for how we proceed with counseling?
  • What are your thoughts on medication?

These questions will help you decide if you want to accept counseling and choose a suitable approach, if so.

How do I create my own counseling intake form on

If you're looking to create your own counseling intake form, there are a few different ways to do it. You can use a pre-existing template, or you can create your own from scratch.

Creating online forms and surveys is much easier than ever before. Without needing to code a single line, you can simply create forms or surveys and customize its fields, design, and general options with just a few clicks through’s intuitive form builder interface. After that, you can share using one or more of many sharing options and start collecting responses immediately. 

Powerful features: 

  • Conditional logic 
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  • Calculator for exams and quote forms
  • Geolocation restriction
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  • Detailed design customization

Forms and surveys that are created on can be easily integrated with many third-party applications via Zapier. You can integrate with more than 500 third-party applications such as Slack, MailChimp, and Pipedrive. For example, you can create contacts on MailChimp and send notifications to a specific Slack channel per submission you received through your forms.

It is alright if you don’t want to put in more time to create a form from scratch. Jumpstart with one of many ready-to-use templates and get to the work of collecting responses without bothering yourself at all. If you would like to, you can customize your template’s form fields, design and adjust general form settings.

You can share your forms in any way you like. If you want to share your form and collect responses through your form’s unique link, you can simply adjust privacy settings and copy-paste your form link anywhere. And if you would like to embed your form in your website, you can easily copy and paste embed code in your website HTML.

On, you can customize your form’s theme and design elements in depth. Once you switch to the ‘Design’ tab after getting your form done, you will see many different design customization options. You can change your form theme by choosing your own colors or picking one of many ready-made themes.