Intake form templates, field by field

Why an intake form cannot be a noun swap

The four forms here look similar in shape and differ almost entirely in their middle. A physiotherapy intake asks what the injury is, how it happened, what makes it worse and where the pain sits on a scale. A chiropractic intake asks about spinal history, previous imaging and the red flags that rule treatment out. A massage intake asks about pressure preference, areas to avoid and the contraindications that change the session. A psychology intake asks about the presenting concern, mood, risk and who else is involved in care. Copying one discipline's questions into another produces a form that collects the wrong history.

Consent and privacy sit inside the form, not beside it

Each of these forms carries a signature field so the client can consent before the first session rather than at the desk. That is why all four use the classic layout, since a signature component only exists there. Each also puts a plain paragraph above the health questions saying what is collected, who reads it and how long it is kept, because a classic field's description is not shown to the person filling it in. None of them collects a Medicare number or card details, which belong in a practice management system rather than an intake form.

Adapting one to your practice

Start from the discipline closest to yours, then change three things. First the history section, which is the part that carries your clinical reasoning. Second the consent wording, which should match what your professional board and your insurer expect. Third the referral question, since practices that take GP referrals need the referrer's details captured up front and practices that do not can drop the field. Every page lists each field in order with what it collects, so the edit is a matter of deletion and rewording rather than starting again.

Every page in this collection

• Accountant new client form that never asks for a TFN

  Half of what an accounting firm needs from a new client is structural, the entity, the ABN, the GST cycle and the software, and the one thing it must not collect in a web form is the tax file number. This sixteen field new client form gets the first list and refuses the second, asking instead how the number will be handed over.

• Acupuncture intake form that asks the traditional questions

  An acupuncturist needs answers that sound irrelevant to the person giving them, because temperature, thirst, digestion and sleep are read together as a pattern rather than as separate complaints. This fifteen field intake form asks all five of the traditional questions, then screens for the nine things that change how needling is done.

• Buyer enquiry form for a real estate agency, one question at a time

  A buyer enquiry form earns its place when it can rank a caller against a listing before anyone picks up the phone. This one asks for the suburbs, the budget band and where the finance is up to, which are the three answers that decide whether a buyer hears about a property early or reads about the sale afterwards.

• Child psychology intake form with two guardian signatures

  A child psychologist needs three histories before the first session: the development, the school and the household, and the consent of everyone with parental responsibility. This twenty two field intake form collects all four, and ends with two signature boxes rather than one.

• Chiropractic intake form with a spine history grid

  A chiropractor examining a lower back needs to know what the neck, the mid back and the jaw have been doing for the last three months, and asking that one region at a time takes the whole appointment. This seventeen field form puts eight regions in a single grid and screens for the conditions that change the plan.

• Cosmetic clinic consultation form with a treatment history table

  The question that decides a cosmetic appointment is rarely what the client wants, it is what they have already had and when. This seventeen field consultation form takes a dated table of previous treatments alongside the skin type, the medications and the pregnancy question, and is explicit that it books nothing.

• Couples counselling intake form, one form for each partner

  A couples intake form that is filled in together gets one story twice, which is exactly what the counsellor did not need. This fourteen field intake form is sent to each partner separately, and it carries the two questions that only work in private: the safety screen, and where each person actually is with the relationship.

• Dietitian intake form built around a 24 hour recall

  A dietitian cannot plan anything from a person saying they eat pretty well, which is why the first appointment usually burns twenty minutes reconstructing yesterday. This sixteen field intake form takes that reconstruction as a six row table the night before, alongside the conditions, allergies and funding pathway the practice needs.

• Dog grooming intake form with the matting consent already signed

  A grooming appointment goes wrong in two ways: the coat is worse than the booking allowed for, or the dog will not tolerate the dryer and nobody warned the groomer. This intake form asks about both before the appointment, and it takes the matting consent in writing so the conversation at the table is about the coat rather than about permission.

• Financial planning fact find with five tables and a risk profile

  An adviser cannot recommend anything until the whole balance sheet is on one page, which is why a fact find is long and why most of it is tables rather than questions. This twenty four field fact find carries goals with dollar figures, assets and liabilities, every super fund and every existing policy, then a seven statement risk profile.

• Home care intake form that asks about the house too

  A home care visit fails on practical things long before it fails on clinical ones: the step with no rail, the dog behind the gate, the key nobody mentioned. This twenty field intake form collects the package level and the services alongside the access notes that decide whether the first visit works.

• Interior design client questionnaire that starts with the rooms

  An interior design questionnaire is worth filling in when it changes what the designer brings to the first meeting. This one settles the rooms in scope, the budget and what that budget is expected to cover before anybody talks about style, then asks what the client is keeping and who actually signs off.

• Lactation consultant intake form built around a feeding log

  A lactation consultation is decided by two things a parent already has: the last twenty four hours of feeds, and how the first week went. This sixteen field intake form collects both as an eight row log and a first week checklist, alongside the pain, the supply worries and the pumping.

• Law firm client intake form with the conflict check on it

  A firm cannot give a word of advice until it knows who else is involved, because acting against an existing client is the one mistake that ends a matter before it starts. This fifteen field intake form puts the conflict check on the form as a four row table of other parties, and says plainly that the enquiry engages nobody.

• Massage intake form that asks about pressure before the table

  A client lying face down with their eyes closed will almost never ask for lighter pressure or say that they would rather their feet were left alone. This fourteen field intake form asks both in advance, alongside a contraindication screen that adapts the technique rather than cancelling the booking.

• Midwifery intake form for a private booking visit

  A booking visit with a private midwife is ninety minutes and should mostly be about what the woman wants, not about reconstructing her history out loud. This twenty field intake form takes the due date, the previous pregnancies, the blood group and the birth preferences beforehand, and asks who will be in the room.

• Mortgage broker fact find a lender can read in one sitting

  A fact find is the document a loan application is actually built from, and it falls apart when income, debts and living expenses arrive in three emails a week apart. This one takes all three as tables on a single form, with the loan purpose at the top and the credit consent signed at the bottom.

• Naturopath intake form with an eight system review grid

  A naturopathic consultation asks about eight body systems and everything already being swallowed, and doing that inventory out loud costs most of a first appointment. This nineteen field intake form takes the grid and the supplements table beforehand, so the ninety minutes go on the conversation instead.

• NDIS intake form that starts from the plan itself

  An NDIS provider cannot start a support without five things off the plan: the participant number, the two dates, the management type and the goals. This nineteen field intake form asks for all five, plus the participant name as the plan shows it, and tells them to have the plan open while they answer.

• Occupational therapy intake form built on a daily living grid

  An occupational therapist is asked to change how a day works, so the intake has to describe the day rather than the diagnosis. This eighteen field intake form takes an eight task support grid, the equipment already in the house, and the funding with its plan dates, before the first home visit is booked.

• Optometry intake form that asks about the family too

  Half of what an optometrist looks for at a first examination is decided by two things the patient already knows: how their eyes are used, and what runs in their family. This fourteen field intake form collects both, along with the screen hours, the driving pattern and the general health that change what the examination tests.

• Personal training intake form with the readiness screen built in

  A personal training intake form collects a client's goals, a seven question pre exercise readiness screen, training history, injuries, how many sessions a week they can manage and baseline measurements, before the first session. This fifteen screen intake asks the readiness questions one at a time the day before, because asking them face to face at the start of session one wastes the session and gets softer answers.

• Physiotherapy intake form built around one injury

  A physiotherapist has about forty minutes and needs a third of it to examine, so the history has to arrive before the patient does. This eighteen field intake form maps the region and side, the onset, the pain score and what aggravates it, then records which funding pathway is paying.

• Pilates intake form that asks the postnatal question properly

  A reformer is set up per person, so a pilates studio needs the injuries and the pregnancy stage before the class rather than in the doorway of it. This eleven screen intake form asks those one at a time, with a womens health clearance question that leads to a referral rather than a refusal.

• Podiatry intake form that asks about diabetes first

  Two answers decide how a podiatry appointment is run before the podiatrist has seen a foot: whether the patient has diabetes, and whether the circulation and nerve supply are intact. This fifteen field intake form asks both in the first health block, then collects the footwear, the standing hours and the orthotics history that explain the rest.

• Psychology intake form with the limits of confidentiality on it

  A first psychology session has fifty minutes and a person who has usually waited weeks for it, so the history should not eat the first twenty. This twenty field intake form takes the referral pathway, a ten item distress baseline and the supports already in place, and states the limits of confidentiality above the signature.

• Sleep consultant intake form with a three day sleep diary

  No sleep plan can be written from one night, because one night is either the good one a parent remembers or the terrible one that made them book. This fifteen field intake form collects three days as a diary table, plus the room, the routine and the way the child actually falls asleep at bedtime.

• Speech pathology intake form as a child case history

  A paediatric speech pathologist starts from a case history that reaches back to birth, because prematurity, early feeding and the age of first words each change what a delay is likely to be. This twenty one field intake form collects that history, the hearing testing, the languages spoken at home and the funding, before the first forty five minute session begins.

• Tutoring intake form that reaches the tutor before the student does

  A first tutoring session spent working out what the student already knows is a session the family paid for and did not get. This intake form collects the year level, the subjects, the most recent school report and a plain answer to what tutoring should change, so the tutor arrives having read the teacher comments rather than discovering them.

• Wedding planner questionnaire that asks about the budget out loud

  A wedding planner questionnaire has one job before the first meeting: work out whether the date, the guest count and the budget can exist in the same room. This one asks all three in the first four screens, then spends the rest of its questions on the things a couple actually argues about, which are the must haves, the vendors already locked in and who is doing the planning.