In the video above I describe the 6 different client intake forms in the Private Practice Starter Kit that would be considered client intake forms.
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The six client intake forms in the Private Practice Starter Kit are the:
1. Phone Intake
2. Personal Information and Insurance
4. Intake Assessment
5. Information and Consent
6. Release of Information
First, the Phone Intake – this is where it begins. A 1 page form that guides you or your secretary through the phone intake interview. TAKE note of the Referred By prompt and make sure you send a thank you note to the person who made the referral.
Second, Personal Information and Insurance – collects all the important information to bill insurance if your client is using behavioral health benefits. The kit comes with 2 forms: one that assigns benefits to the therapist and another that assigns benefits to the client.
Third, Biopsychosocial, 5 page comprehensive biopsychosocial – this is the most important part of the intake. This form has a holistic bent to it – it covers everything from symptoms, to mental health history, nutrition, to spiritual history as well as abuse, developmental history and much more. This form will lead the way to completing a comprehensive assessment that will help begin to unfold the client’s underlying issues so together with your client you can develop a treatment plan that will result in client success.
Fourth, Intake Assessment, this is where you summarize your clinically important findings from the biopsychosocial and intake interview. This is also the form you use to document the mental status exam, clinical and diagnostic impressions.
Fifth, Information and Consent, you should not do therapy without a signed informed consent. This form covers all the general basis you need to inform your client of before beginning therapy. When I put together my own personal intake forms I consulted with an attorney. You may want to do the same especially regarding your Information and Consent form. But the nice thing about this form is, if you are using Microsoft word you can easily tweak it to add or delete words or segments to make it fit your own counseling philosophy.
Finally, the Release of Information, when in the best interest of your client, use this form to get your client’s permission to speak with others about your client’s treatment
Robust forms like these will assist you in conducting a thorough and effective intake that will get counseling started on the right foot.