Intake Assessment Form

Customize template

Register new clients’ essential info by asking them to fill this rapid intake assessment form. Take this pre-designed template as a model that you can modify to comprise any data that is essential to your activity. And most of all, to your client – after all, that’s where your focus is, right? This intake assessment form example includes contact information, referrer information, emergency contact information and how to best reach your client (including whether or not discretion is required). Just review all our proposed sections and add more fields where necessary with the drag & drop editor. For example, a short medical history or self-care habits. Or a Likert scale field to assess work-related stress. On the contrary, you can remove superfluous fields if needed. In any case, consider questions that would be client specific, but potentially impactful to treatment.

Publish template

Short after you’ve completed the behavioral health intake assessment form, you’ll want it available for your clients. Don’t worry, sharing it is a piece of cake with our friendly platform. You only need to copy and paste the form code to send it via email, post on social platforms or embed it in a web page. Furthermore, publishing options also include JavaScript, iFrame or popup lightboxes. Of course, since the form is mobile responsive, clients can fill it out on their phone. Or better yet, you can provide it on a tablet at the reception desk.

Collect & manage data

Get the most out of intake and evaluation forms! Your client data is securely gathered in an organized data table that you can view and manage directly on our platform. On the contrary, you can export the database if you want. For example, as a CSV, Excel or PDF file. Besides, if you are used to a file management app to improve your client records, go ahead and check out our multiple third-party integrations.

Optimize processes

With 123 Form Builder you’ve got plenty of options for how you can make the intake process individualized to your clients and your practice. Plus, it requires no coding skills, so you can do it by yourself. This fully adaptable intake assessment form sample allows you to receive instant email or SMS notifications each time a client fills the form. So why not give up the paper mess and start building effective digital intake forms?