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Counselling Intake Assessment Form Template

Leverage this ready-to-use counselling intake assessment form template with a questionnaire and conversational UI to simplify the registration and initial assessment process at your counselling clinic. It helps to keep the patient records in a systematic way by reducing the paperwork. 

How does this Counselling Intake Assessment Form Template help? 

A counselling intake form is a tool used by mental health professionals like you to collect valuable information that will help you treat your patients more effectively. For several reasons, a counselling intake form is extremely useful to the practitioner:

  • It provides documented responses to critical questions.
  • It highlights your patient's therapy and another practitioner's history.
  • It displays a patient's medical history.
  • It displays a patient's therapy objectives and documents preferred payment methods.
  • It emphasizes the therapeutic relationship.

Get started right away with a free trial. 

 

How to Use this Counselling Intake Assessment Form Template?

If you need an intake evaluation counselling form, you can use this template to get started by gathering important information. No coding is required to fully customize the template, change, add or remove fields, change fonts, colors, layout, and background using the Zonka Feedback builder. This Counseling Intake Assessment Form, like all of our templates, is fully responsive.

 

List of Counselling Intake Assessment Form Questions

The following questions are included in the Counselling Intake Assessment Form Template:

  • Can you tell us your full name?
  • And your date of birth?
  • Can you fill in your personal details?
  • Can you tell us the name and phone number of your primary care provider?

Sign Up on Zonka Feedback for free and implement this Counselling Intake Assessment Form Template in your account to collect feedback.

 

FAQs about Counselling Intake Assessment Form Template

1. What is the counselling intake assessment form template?

A counselling intake form is a tool used by mental health professionals like you to collect valuable information that will help you treat your patients more effectively. A counselling intake form is extremely useful to the practitioner for several reasons, including the fact that it provides documented answers to important questions.

2. Where can I use this Counselling Intake Assessment Form Template?

You can use a QR code at your touchpoint. Another method is to send an email or SMS survey to the customer once the service is completed. If you don't have access to the internet, you can conduct offline surveys using kiosks, mobile devices, or tablets. 

Create and send this Counselling Intake Assessment Form Template

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