Form questions
Mental health intake questions before a first session
Ask 15 to 20, most of them optional. Never skip the reason for coming in the client's own words, the safety question with crisis lines printed directly above it, and informed consent to counselling. Everything else can wait for the first session if the client would rather say it aloud.
A mental health intake has to tell the clinician why this person is asking for help now, what has been tried before, and whether anyone is at risk before the first appointment. These questions gather that without turning a first contact into a clinical interview, and they leave room to say more in the room.
The questions
About you
NameNameRequired
The name you would like to be calledShort text
PronounsShort text
Date of birthDateRequired
Tells the practice straight away whether a guardian's consent is part of the picture.
Mobile numberShort textRequired
May the practice leave a voicemail on that number?Single choice
Asked on its own, not folded into the number box. Treat a blank answer as no.
Email addressShort text
Short text, since the email component renders nothing on a published classic form.
Emergency contact, relationship and phoneShort textRequired
GP name and practiceShort text
How were you referred?Single choice
What brings you here
In your own words, what brings you to counselling now?Long textRequired
Say in a paragraph above it that one sentence is enough. The first session plan starts from this answer.
How long has this been going on?Dropdown
What would you like to be different in three months?Long text
Over the last two weeks, how often have youRating grid
A short screening grid, not a diagnosis. Keep rows and columns identical at every review so change shows.
How much is this affecting your work, study or daily life?Single choice
Not at all, a little, quite a lot, a great deal.
History and current supports
Previous counselling or psychiatric careSingle choice
Has a health professional ever told you that you have any of these conditions?Multiple choice
Always include prefer not to say as an option.
Current medicationsLong text
Who or what supports you at the moment?Multiple choice
Partner, family, friends, GP, another health professional, a community group, nobody right now.
How often do you drink alcohol?Single choice
Do you use any other drugs, including medication not taken as prescribed?Single choice
Safety
Have you had thoughts of harming yourself in the last month?Single choiceRequired
No, yes, prefer to discuss in session. Print Lifeline 13 11 14 and 000 in a paragraph block directly above it.
Do you feel safe at home?Single choice
Yes, no, prefer to discuss in session.
Consent and practical details
Would you prefer sessions in person, by video or by phone?Single choice
Is there anything that makes attending hard, such as transport, childcare or work hours?Long text
Do you consent to counselling on the terms described above?Single choiceRequired
I consent, or I have questions before I consent, so a question never forces a false yes.
SignatureSignature
Which questions to make required
Seven questions are required: name, date of birth, mobile, emergency contact, the reason for coming, the safety question and consent. The first four let the practice reach the client and know whether a guardian is involved, and the last three are what a clinician needs before seeing anyone. History, medication and substance use stay optional, because a client who is not ready to write them down should still be able to book.
- Name
- Date of birth
- Mobile number
- Emergency contact, relationship and phone
- In your own words, what brings you to counselling now?
- Have you had thoughts of harming yourself in the last month?
- Do you consent to counselling on the terms described above?
The form built from these questions
A static copy of the finished form, from its own example page.
Three ways to change this bank
For a youth service, add the parent or guardian's name and phone, ask the young person and the guardian for consent as two separate questions, and replace work with school in the impact question. Keep date of birth required, since it decides who must consent. For couples counselling, send one form to each partner rather than a shared form, and keep the safety and home questions on each person's own form so neither answer is written with the other watching. For an employee assistance program intake, add the employer name and the number of sessions approved, and state in a paragraph block exactly what the employer is told, if anything, before any clinical question is asked.
Questions people ask
How many questions should a mental health intake form have?
Around fifteen to twenty, and it should take ten minutes or less. A long intake before a first session delays people at the moment they finally asked for help. Collect what the clinician must know before the appointment, and leave detailed history for the session itself, where it can be followed up properly rather than read cold.
What should happen when a client answers yes to the safety question?
Someone at the practice should see it the same day. The email alerts add-on sends each submission's values to one address, so route it to a monitored inbox rather than a personal one. A form is never a crisis service, which is why the crisis lines sit above the question for anyone who needs help before a reply arrives.
Is the health information on an intake form covered by privacy law?
In Australia, health information is sensitive information under the Privacy Act, so a practice should collect only what it reasonably needs, with consent, and tell clients how it is stored and used. The Office of the Australian Information Commissioner explains the collection rules for health service providers. Put a short collection notice above the first question.
Should an intake form ask about alcohol and drug use?
Yes, as two optional frequency questions rather than one combined question. Substance use changes how anxiety, sleep and mood present, and it matters for medication. Asking about alcohol and other drugs separately keeps each answer honest, and making both optional means a client can leave them for the first session without abandoning the form.
What should the consent question cover?
The limits of confidentiality, fees and cancellations, how records are kept, and the client's right to stop at any time. Put those terms in a paragraph block above the question, because a classic field description is not shown to the person filling in the form, then ask for consent with an option to raise questions first.
Can a family member fill in the intake for someone else?
For an adult client, the client should complete it, because the reason for coming and the safety answer need to be theirs. A family member can help with practical details. For a child or teenager, use the youth version, where a guardian and the young person each answer the questions meant for them.
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On writing the questions themselves, read How to write an intake form for any practice. For everything the builder can do, see the form maker. Step by step: Create a form with AI, then Control who can fill in your form.
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