Client Intake Form with Insurance Fields for Therapists and Coaches

Does your practice work with insured clients? This intake form has you covered.

The Client Intake Form with Insurance Fields gives your clients a clear, professional way to share everything you need before their first session. Alongside all the essential client details, this form includes dedicated fields for insurance provider and policy number so you have everything in one place from day one.

No more chasing information after the fact. No more messy Word documents. Just a beautifully designed, fully branded form that reflects the professionalism of your practice.

Fully editable in Canva. Add your logo, practice name and contact details in minutes. Download once and use forever.

What is included: A4 and US Letter sizes. 6 sections covering client details with insurance provider and policy number, emergency contact, presenting concerns, goals, medical and mental health history, and consent and declaration.

How it works: Purchase and instantly receive a link to your Canva template. Open it, make a copy, add your branding and download as PDF. Print or send digitally to your clients.

Instant download. No waiting. No subscription.