About this template
Streamline your new client onboarding process with this comprehensive Psychology Intake Google Form template. Designed specifically for mental health clinics, therapists, and counselors, this form securely gathers essential patient information before their first appointment. It collects vital details including personal contact information, emergency contacts, insurance data, medical and psychological history, and current symptoms.
Using Doc2Form to deploy this intake questionnaire helps mental health practitioners save valuable time during initial sessions, allowing them to focus entirely on the client's care and treatment goals. The structured layout ensures you never miss critical disclosures or consent documentation, keeping your practice organized and compliant. With Doc2Form, you can instantly turn this template into a live Google Form, share it via a secure link in your booking emails, or embed it directly into your practice website for seamless patient registration.
Key features
- Collect complete medical and psychological history before the first session.
- Capture essential emergency contact and insurance details.
- Streamline new client onboarding with a pre-formatted questionnaire.
- Easily embed on your practice website or share via email.
- Organize patient responses automatically in Google Sheets.
Use cases
- New client registration for private therapy practices
- Initial psychological assessments at community mental health clinics
- Student counseling intake at universities and schools
- Telehealth psychotherapy onboarding workflows
What this form collects
- Full Name (Short answer)Enter your first, middle, and last name.
- Date of Birth (Date)Enter your date of birth (MM/DD/YYYY).
- Phone Number (Short answer)Best number to reach you for appointment reminders and updates.
- Email Address (Short answer)Where we can send telehealth links and paperwork.
- Residential Address (Paragraph)Street address, city, state, and zip code.
- Emergency Contact Name (Short answer)Full name of your designated emergency contact.
- Emergency Contact Relationship (Short answer)E.g., Spouse, Parent, Sibling, Friend.
- Emergency Contact Phone Number (Short answer)Primary phone number for your emergency contact.
- Have you previously attended therapy or counseling? (Multiple choice)Select the option that best describes your experience.
- Current Symptoms or Concerns (Paragraph)Briefly describe what brings you in today and what symptoms you are experiencing.
- Current Medications (Paragraph)List any prescription medications, dosages, or supplements you are currently taking.
- Primary Goals for Therapy (Paragraph)What do you hope to achieve through our work together?
- Acknowledgment of Practice Policies (Multiple choice)I confirm that the information provided is accurate and I understand the confidentiality and cancellation policies of this practice.
- Electronic Signature (Short answer)Please type your full legal name to serve as your electronic signature.
FAQ
Why is a psychology intake form used?
It gathers essential medical and psychological history, emergency contact details, and treatment consent so mental health professionals can accurately assess and prepare for new clients.
What should be included in a psychology intake form?
It should include personal contact information, insurance details, medical and mental health history, current symptoms, emergency contacts, and therapy goals.
Who can use this psychology intake template?
Licensed psychologists, therapists, counselors, social workers, and mental health clinics can use this template to streamline their client onboarding.
How do I customize this template for my practice?
With Doc2Form, you can instantly convert and customize this template into a Google Form, allowing you to add your practice logo, adjust questions, and collect responses directly in Google Drive.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.