The intake form does more work than most therapists realise. It sets the tone for the first session, captures information that shapes the work, and provides legal documentation of consent. A bad intake form creates work; a good one saves it.
This is a working intake template for a small Indian therapy practice in 2026, with rationale for each section.
The 14 questions
1. Full name (legal, and chosen name if different). Capture both. Some clients use a name different from their official documentation. The chosen name is what you use in session; the legal name is what goes on the invoice and any formal record.
2. Age and date of birth. Both. DOB is the formal record; age is the practical reference. Both fields take 5 seconds.
3. Contact information. Email, mobile, preferred mode of contact. Specify what each is used for — appointment reminders, emergencies, billing.
4. Address (if relevant). Required for invoicing if the client needs a formal invoice for tax or insurance purposes. Otherwise optional.
5. Emergency contact. Name, relationship, phone number. The person you’d contact in a clinical emergency if you can’t reach the client. The client should explicitly nominate this person.
6. Brief description of what brings them to therapy.
A free-text field. Doesn’t need to be long. “Stress at work and relationship issues” is fine; you’ll explore in session. The purpose is to give you context before the first session.
7. Previous therapy or psychiatric treatment.
Have they seen a therapist before? When? What was that experience like? Are they currently working with a psychiatrist or on medication? Brief field.
8. Current medications.
Including non-psychiatric medications. Drug interactions and psychological side effects matter for clinical work.
9. Significant medical history.
Not exhaustive. Conditions that might affect the work — chronic illness, recent diagnoses, neurological conditions.
10. Family/relationship structure.
Brief. Who do they live with? Single/partnered/married? Children? This is context, not investigation.
11. Occupation.
Job, employer, work pattern. Affects scheduling and is sometimes clinically relevant.
12. How did they find you?
Referral source. Useful for tracking which channels actually work for your practice.
13. Languages they’re comfortable working in.
If you offer multiple languages, ask. Don’t assume.
14. What would be helpful for me to know before our first session?
A free-text open field. Some clients use this to disclose something important they want you to know in advance. Others leave it blank. Either is fine.
What to skip
A few things often included that don’t actually help:
- A long childhood-history questionnaire (you’ll explore this in session)
- Detailed sexual history (intrusive at intake; address as relevant later)
- A symptom checklist of 50+ items (use validated brief scales like PHQ-9 and GAD-7 instead if you want screening)
- Questions about religion or politics (not relevant at intake; if relevant later, ask then)
- Demographic boxes that don’t serve the work
The principle: capture what you’ll use; skip what you won’t.
The consent paragraphs
This is where intake forms most often fall short. A complete consent section includes:
1. Confidentiality and its exceptions.
Sessions are confidential. Information you share with me will
not be disclosed to anyone without your consent, with the
following limited exceptions:
- If you indicate imminent risk of serious harm to yourself or
others
- If there is suspected abuse of a child, elderly person, or
person with a disability
- If required by court order or legal subpoena
- If specific consultation with my clinical supervisor is needed
for the quality of your care
2. Records.
I will keep written records of our work. These records belong
to your treatment and are stored securely. You have the right
to access basic information from your records on request.
Records are retained for [X] years after the conclusion of
treatment, then destroyed.
3. Fees and cancellation.
My fee for individual sessions is ₹[amount]. Payment is due
within 7 days of the session. Cancellation within 24 hours of
a scheduled session is charged at full fee, except in cases
of emergency.
4. Telehealth (if applicable).
Sessions may be conducted in person or via secure video call.
You understand the limitations of telehealth, including
technical interruptions and reduced ability to assess safety
in crisis. You agree to share your physical location at the
time of telehealth sessions.
5. Your right to terminate.
You may end therapy at any time without explanation. I encourage
a brief closing process when ending, but it is not required.
6. Communication between sessions.
I am available between sessions for scheduling and brief
updates via [email/WhatsApp/whatever]. I do not conduct therapy
between sessions. In crisis, please contact [helpline numbers]
or your nearest hospital.
7. Signature.
I have read the above and agree to these terms for therapy.
Name: ____________________
Date: ____________________
Signature: ____________________
For online forms, a typed name plus a checkbox can serve as signature; for higher-stakes practices, an actual e-signature service.
What to do with the form
A specific workflow:
Step 1. Send the form to the client when they book the first session. Email link if it’s online; PDF attachment if not.
Step 2. Ask them to complete it before the first session.
Step 3. Review the form before the first session. Five minutes; you’ll have context.
Step 4. In the first session, briefly check that the information is current. Ask if anything has changed since they filled it out.
Step 5. Store the form in the client’s record.
Don’t use the first session to fill out the form. That wastes half the session on administration.
Online vs paper
Online wins on:
- Less work for client (can fill at home)
- Easier to update or revise
- Searchable in records
- Easier to share with consent if needed
Paper wins on:
- No tech barrier for less digitally-comfortable clients
- Sometimes preferred for the act of physical signature
- Doesn’t depend on email reliability
A working compromise: offer both. Default is online; paper on request.
Specific Indian-context additions
A few useful additions for India:
GST number field. If the client wants invoices in a business name with GST, capture the GSTIN at intake. Saves friction later.
HSN/SAC code understanding. Some clients (corporate) will ask. Have your code ready (often 998314 or 9993).
Mode of payment preferences. UPI, bank transfer, Razorpay link. Knowing the client’s preference smooths the first payment.
Holiday/festival schedule preferences. Indian clients often have specific festival weeks they want to schedule around. Optional question.
What practice-management tools should support
A few specific things:
- Online intake form integrated with the booking flow
- Multi-language templates
- Consent paragraph editable per practice
- E-signature capture
- Form storage linked to the client record
Most tools have basic forms; few have multi-language or robust e-signature. MindMaster has basic forms; multi-language and proper e-signature are on the roadmap.
A close
The intake form is the practice’s first impression. A clear, focused form that respects the client’s time and captures what the practice will actually use builds trust before the first session even happens.
Skip what won’t be used. Include consent that actually covers the practice. Keep the document short enough that clients complete it.
For the operational side, our tool at mindmaster.modoware.com handles form storage and basic creation. The content of the form is something you design once, refine over years.