Free Therapy Intake Form Template

What is a therapy intake?

A therapy intake is the comprehensive initial assessment completed at the first clinical encounter. The intake documents the client's presenting problem, psychiatric history, medical history, family background, trauma history, substance use, social context, mental status, and the clinician's initial diagnostic impression and treatment recommendations. Intakes are among the longest notes most therapists write. They are also the notes most worth automating because they cover the most ground and require the most structured information gathering. A thorough intake creates the clinical foundation for all subsequent work; a rushed intake leads to gaps in essential history and to notes that are incomplete when reviewed by supervisors, insurance auditors, or legal counsel.

What's in this template

This free therapy intake template includes sections covering all essential assessment domains:

• Identifying Information and Chief Complaint: Client name, date of birth, contact information, and reason for seeking treatment
• History of Present Illness: Detailed description of presenting problem, onset, course, current severity, and impact on functioning
• Past Psychiatric History: Prior diagnoses, hospitalizations, medication trials, previous therapy or counseling, and outcomes
• Medical History: Relevant chronic conditions, surgeries, current medications, allergies, and medical providers
• Family History: Mental health and substance-use history in first and second-degree relatives; family structure and dynamics
• Social History: Education, employment, housing, relationships, cultural background, and spiritual beliefs if relevant
• Substance Use History: Current use of alcohol, tobacco, prescription medications, and other substances; age of onset and impact
• Trauma History: Significant losses, abuse, adverse childhood experiences (ACEs), and other potentially traumatic events
• Mental Status Examination: Appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment
• Risk Assessment: Current suicidality and homicidality screening; protective factors
• Diagnostic Impression: DSM-5 diagnoses with diagnostic codes
• Treatment Recommendations: Initial treatment plan outline, modality recommendation, medication consultation needs, and follow-up schedule

The template is comprehensive enough to support initial treatment planning while remaining navigable within a single extended session.

When to use therapy intake format

Therapy intakes are essential for:

• Every new client's first appointment (mandatory documentation)
• Initial psychiatric evaluation or diagnostic assessment
• First session in any new therapeutic relationship
• Documentation required for insurance authorization of ongoing treatment
• Court-ordered or legally mandated evaluations
• Any setting where comprehensive baseline assessment is required
• Supervision or consultation documentation where history must be complete

Most licensing boards and insurance companies require that an intake be completed and documented before ongoing therapy or counseling proceeds. The intake creates the clinical baseline against which all subsequent progress is measured.

How to use the template with Scriber

Instead of writing your intake note from handwritten notes or memory hours after the session, Scriber can generate a draft directly from your session recording. During the intake, you ask the standard assessment questions; Scriber captures the full session, transcribes it, and structures the content into all the intake sections automatically. You then review the draft, fill in any sections that require your direct clinical judgment (diagnostic impression, treatment recommendations, mental-status findings that are not explicit in the transcript), edit for accuracy and tone, and sign. The AI-generated structure and information gathering work is done; you apply the clinical thinking. For busy clinicians managing intake-heavy schedules, this can reduce intake documentation time from two hours to thirty minutes.

Download (free)

This template is available as a PDF and as an editable DOCX file. Customize it with your clinic name, logo, and any additional fields your practice or insurance contracts require.

[Download PDF]

Related templates

Looking for other assessment tools?

• Biopsychosocial Assessment Template — More comprehensive intake with additional depth in biological, psychological, and social domains
• Treatment Plan Template — Document goals and interventions that flow from your intake assessment