Mental Health Intake Form
Gather contact details, care goals, current concerns, history, preferences, and consent before an initial mental health appointment.
Preview
Interact with the actual form experience before opening the template in Formspace. Responses entered here are not saved.
Interactive preview loads automatically when this section scrolls into view.
What's included
A quick static summary of the main sections and fields, so visitors can scan the structure before opening the full template.
👤 Client details
Start with practical contact and appointment information.
Full name, Date of birth, Email address, Phone number, plus 2 more.
🧭 Goals and current context
Describe what you would like support with.
Which areas would you like to discuss?, Rank the topics you most want to focus on first, How difficult have things felt recently?, What would you most like the provider to understand before the first session?, plus 2 more.
📋 History and consent
Share relevant history and consent preferences.
Have you worked with a mental health or wellbeing provider before?, Previous support context, Upload referral letters or relevant documents, Please confirm:, plus 1 more.
How to use this template
When to use it
Use this template when you need a structured intake workflow for Healthcare, Wellbeing, Professional services teams. It works best when the response needs enough context for a reviewer to take the next step without sending several follow-up messages.
How to customize it
- Replace generic labels with language your respondents already use.
- Move optional questions later in the form so the first page stays easy to complete.
- Add internal routing notes or tags if different team members handle different response types.
- Explain exactly which files are useful so respondents do not upload unnecessary documents.
- Place signature fields next to the acknowledgement or consent text they confirm.
Example questions
These visible question examples help you evaluate the template before opening the interactive preview.
Full name
Date of birth
Email address
Phone number
Appointment type
Preferred contact method
Which areas would you like to discuss?
Rank the topics you most want to focus on first
How difficult have things felt recently?
Questions about this template
What is the mental health intake form template for?
A careful intake starting point for counselling, coaching, or wellbeing services that need structured pre-session context without making diagnostic claims. It is a good fit for Healthcare, Wellbeing, Professional services teams that need a structured intake workflow.
Can I customize this mental health intake form template?
Yes. Open it in Formspace to edit questions, pages, logic, branding, publishing settings, notifications, and response handling before sharing it.
What questions are included?
The template includes 17 questions across 3 sections. Example questions include: Full name; Date of birth; Email address; Phone number.