Templates
Client intake form template
A lean, GDPR-minded intake form: the details you need to begin safely, and nothing you don't.
Last updated: July 2026
A good intake form collects what you need to work safely, and nothing more. Under UK GDPR you should be able to justify every field you ask a client to complete, so this template is deliberately lean. Add fields only if you will actually use them, and make sure whatever you collect is reflected in your privacy notice.
How to use it: download the Word version or copy the text, replace the [bracketed] items, delete anything you do not need, and give it to new clients alongside your counselling agreement and privacy notice.
New client details
[Practice name]
Completed information is held in line with our privacy notice: [link or "provided separately"].
About you
- Full name: [ ]
- Name you like to be called: [ ]
- Date of birth: [ ]
- Address: [ ]
- Phone: [ ] May I leave a voicemail? Yes / No
- Email: [ ] May I contact you by email? Yes / No
- Preferred contact method: Phone / Email / Text
In an emergency
- Emergency contact name: [ ]
- Relationship to you: [ ]
- Emergency contact phone: [ ]
Your GP (optional, and only contacted in the circumstances set out in our agreement)
- GP name and surgery: [ ]
- Surgery phone: [ ]
Your wellbeing
- What brings you to counselling at the moment? [ ]
- Have you had counselling or therapy before? Yes / No. If yes, roughly when? [ ]
- Is there anything about your health, medication or circumstances it would help me to know? [ ]
- Is there anything that would make our sessions more comfortable or accessible for you? [ ]
Practicalities
- How did you hear about the practice? [ ]
- Preferred session day/time, if any: [ ]
Confirmation
- I have received the counselling agreement and privacy notice, and I have had the chance to ask questions. Yes / No
- Signature: [ ] Date: [ ]
Notes on adapting it
Keep the wellbeing questions open rather than clinical. This is an intake form, not an assessment tool: the aim is enough context to begin safely, with the fuller picture emerging in the work itself. If you use an online form instead of paper, check where the responses are stored and name that provider in your privacy notice. Store completed forms with the same care as session notes, and remember our guidance on keeping notes applies from the first document you hold.
This is a template to adapt, not legal advice. Please have important wording reviewed by a suitably qualified person before you rely on it.