Therapist New Client Intake Form - Fillable PDF + Word + US Letter A4 A5

Everything a new client completes and signs before the first session, in one packet: contact and emergency details, consent to the use of health information, consent to therapy, a brief initial interview, and your cancellation and payment policy. Fillable PDF and editable Word, in four page sizes.

One document to send, one document to file. Not five separate forms your client has to assemble.

▸ WHAT YOU GET

6 pages. 94 clickable fields and 11 checkboxes. Four page sizes, two file formats:

• Fillable PDF — US Letter, A4, A5, and a 3:4 tablet size for GoodNotes

• Editable Word .docx — the same four sizes

• Instant download

▸ WHAT IS INSIDE

1. Client details — contact information, communication preferences, emergency contact, health care coordination, and current medications. Includes explicit permissions for voicemail, text reminders, and email.

2. Consent to the use of health information — why information is collected, what is collected, retention and disclosure, the client's rights, and five optional consents they tick individually, including consultation and supervision.

3. Consent to therapy — your approach, session length and frequency, how goals are set and reviewed, the limits of confidentiality set out plainly, contact between sessions, emergency resources, and voluntariness. Space to record the goals you agree together.

4. Brief initial interview — what brings them now, how long it has been going on, the effect on daily life, previous therapy, sources of support, and how they prefer to work. Sent ahead of the first session, or completed together.

5. Cancellation and payment policy — fee, payment terms, the cancellation window, what happens when a session is missed, when the fee is waived, and what to do if cost or scheduling becomes the real problem.

Signature blocks where they belong, and a clinician checklist at the end for opening the file.

▸ WRITTEN FOR US PRACTICE

HIPAA language is written in, not left as a bracket for you to fill. The confidentiality section names the actual exceptions — mandated reporting, imminent risk, court orders, insurance billing, de-identified consultation — in language a client can follow. Emergency guidance points to 911 and 988.

▸ WHAT MAKES THIS SET DIFFERENT

• Genuinely fillable. Real PDF form fields, not a flattened image. Tab moves you through the packet, and the checkboxes are real checkboxes.

• Even the placeholders are fields. Bracketed items like [INSERT LENGTH] are clickable — click, select all, type over them.

• Written to be read, not skimmed and signed. A consent form the client actually understands is worth more than one that merely covers you.

• Word versions are fully editable — change the wording, the colors, the footer, and add your logo to the header.

• Print-friendly. White pages with sage and olive accents.

▸ FOUR PAGE SIZES

US Letter and A4 for printing. A5 for a compact file copy — it also prints on Half Letter with your printer's scale-to-fit. The 3:4 tablet size is proportioned for signing and annotating with a stylus in GoodNotes, Notability, or any PDF app.

▸ PLEASE READ BEFORE BUYING

This is an organizational document, not legal or clinical advice. Requirements for consent, privacy notices, record-keeping, and fee disclosure are set by your state law, your licensing board, your professional association, and any payer contract you hold.

A Notice of Privacy Practices is a separate, legally prescribed document with required content — section 2 of this packet is a plain-language consent and summary, not a substitute for it. Please have the consent sections reviewed by an attorney or compliance advisor licensed in your state, and adapt the wording to your jurisdiction, before using them with clients. Buying this packet does not create a professional relationship between us.

▸ TERMS OF USE

Licensed for use within a single practice, including clinicians you employ or contract. Edit freely and use with your own clients. Not for resale, redistribution, sharing, or publication as a template product.

▸ NEED THE WHOLE SET?

This packet is also part of the Private Practice Paperwork Kit — 43 forms covering intake, consent, assessment, session notes, treatment planning, records, and billing, including a superbill and a Good Faith Estimate. If you are setting up a practice rather than filling one gap, start there instead.

▸ INSTANT DOWNLOAD

Digital product, nothing shipped. Files are available immediately after purchase. Returns are not possible for instant downloads, but if a file is damaged or not as described, message me and I will put it right.

Questions before you buy? Send me a message — I usually reply within 24 hours on business days.