Health & Wellness
Mental Health Intake Questionnaire Form Template
Gather background information from clients before a therapy or counselling session.
Questions included
1.Full name
Short TextRequired
2.Date of birth
DateRequired
3.Email address
EmailRequired
4.Phone number
PhoneRequired
5.What brings you in today?
Long TextRequired
6.How long have you been experiencing this?
Dropdown
7.Have you previously received therapy or counselling?
Yes / No
8.Are you currently taking any psychiatric medications?
Yes / No
9.What are your goals for therapy?
Long Text
Use this template
Customize this template to fit your needs. Works in both conversational and classic mode.
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