Therapy intake form: a gentle first step for new clients

People often write a long email to a new therapist, or nothing at all. I would rather offer a short, kind set of questions. Clients answer when they feel ready, and you see the main themes before the first call.

Use this when

You take new clients by link and want the basics before you reply.

Skip it when

You need a clinical risk assessment, a crisis line or a signed treatment agreement. A form cannot do those. It is not watched in real time.

What is asked and why

Name, email and the contact preference come first, since contact needs care. Who therapy is for shapes the whole plan. Reasons and goals tell you if you are the right fit. Earlier therapy, support and format give context. A last box says the form is not an emergency service.

What the client's AI would ask

"Who is therapy for?" Then "What brings you to therapy?" Then "How would you like to meet, in person or by video?" It shows all answers and sends only after a yes. Read about agent-fillable forms.

Check your local privacy rules before collecting health data. This is a form, not medical advice. Have a professional check any consent wording. Related: a coaching intake form for goal work and a therapist referral form for referrals. Browse forms for therapists.

Questions

Why ask how it is safe to contact the client?

Some clients share a phone or a home with people who do not know about therapy. The contact question lets them say whether voicemail, text or email is safe.

Can this work for couples or family therapy?

Yes. The first question names who therapy is for. For couples, ask each partner to fill their own copy, so each person can answer honestly.

Can a client let their AI answer?

Yes. The client pastes the agent prompt into their chat. The AI asks for what is missing, shows every answer and submits only after the client says yes.

Or paste the JSON

Give this to your AI. It needs the AI Form API MCP server or an API key. It makes the form and sends you the link.

text

Create this form with the AI Form API create_form tool (or POST https://aiformapi.com/v1/forms with my API key). Then reply with the public_url.

{
  "title": "Starting therapy",
  "description": "Share what you feel comfortable sharing. You can say more in the first session. This form is not watched in real time and is not for emergencies.",
  "fields": [
    {
      "id": "client_name",
      "label": "Your name",
      "type": "short_text",
      "required": true,
      "max_length": 150
    },
    {
      "id": "preferred_name",
      "label": "Name you would like me to use",
      "type": "short_text",
      "max_length": 100
    },
    {
      "id": "client_phone",
      "label": "Phone",
      "type": "phone"
    },
    {
      "id": "client_email",
      "label": "Email",
      "type": "email",
      "required": true
    },
    {
      "id": "safe_to_message",
      "label": "How may I contact you?",
      "type": "single_choice",
      "required": true,
      "options": [
        "Voicemail is fine",
        "Text messages only",
        "Email only",
        "Please do not leave messages"
      ]
    },
    {
      "id": "therapy_for",
      "label": "Who is therapy for?",
      "type": "single_choice",
      "required": true,
      "options": [
        "Myself",
        "My partner and me",
        "My child or teen",
        "My family"
      ]
    },
    {
      "id": "reasons_for_therapy",
      "label": "What brings you to therapy?",
      "type": "multi_choice",
      "options": [
        "Anxiety",
        "Low mood",
        "Stress",
        "Relationship problems",
        "Grief or loss",
        "A big life change",
        "Past trauma",
        "Work or burnout",
        "I am not sure yet"
      ]
    },
    {
      "id": "change_wanted",
      "label": "What would you like to be different in a few months?",
      "type": "long_text",
      "max_length": 1500
    },
    {
      "id": "earlier_therapy",
      "label": "Have you had therapy before?",
      "type": "single_choice",
      "options": [
        "Never",
        "Yes, in the past",
        "I am in therapy now"
      ]
    },
    {
      "id": "support_around_you",
      "label": "Who supports you?",
      "type": "multi_choice",
      "options": [
        "Partner",
        "Family",
        "Friends",
        "A faith community",
        "Colleagues",
        "Not much support right now"
      ]
    },
    {
      "id": "session_format",
      "label": "How would you like to meet?",
      "type": "single_choice",
      "options": [
        "In person",
        "By video",
        "Either is fine"
      ]
    },
    {
      "id": "free_times",
      "label": "When are you usually free?",
      "type": "multi_choice",
      "options": [
        "Weekday mornings",
        "Weekday afternoons",
        "Weekday evenings",
        "Weekends"
      ]
    },
    {
      "id": "not_emergency_ack",
      "label": "I understand this form is not an emergency service",
      "type": "checkbox",
      "required": true,
      "help": "In a crisis, call your local emergency number or a crisis line."
    }
  ]
}

Or call the API

bash

curl -X POST https://aiformapi.com/v1/forms \
  -H "Authorization: Bearer $AIFORMAPI_KEY" \
  -H "Content-Type: application/json" \
  -d '{"title":"Starting therapy","description":"Share what you feel comfortable sharing. You can say more in the first session. This form is not watched in real time and is not for emergencies.","fields":[{"id":"client_name","label":"Your name","type":"short_text","required":true,"max_length":150},{"id":"preferred_name","label":"Name you would like me to use","type":"short_text","max_length":100},{"id":"client_phone","label":"Phone","type":"phone"},{"id":"client_email","label":"Email","type":"email","required":true},{"id":"safe_to_message","label":"How may I contact you?","type":"single_choice","required":true,"options":["Voicemail is fine","Text messages only","Email only","Please do not leave messages"]},{"id":"therapy_for","label":"Who is therapy for?","type":"single_choice","required":true,"options":["Myself","My partner and me","My child or teen","My family"]},{"id":"reasons_for_therapy","label":"What brings you to therapy?","type":"multi_choice","options":["Anxiety","Low mood","Stress","Relationship problems","Grief or loss","A big life change","Past trauma","Work or burnout","I am not sure yet"]},{"id":"change_wanted","label":"What would you like to be different in a few months?","type":"long_text","max_length":1500},{"id":"earlier_therapy","label":"Have you had therapy before?","type":"single_choice","options":["Never","Yes, in the past","I am in therapy now"]},{"id":"support_around_you","label":"Who supports you?","type":"multi_choice","options":["Partner","Family","Friends","A faith community","Colleagues","Not much support right now"]},{"id":"session_format","label":"How would you like to meet?","type":"single_choice","options":["In person","By video","Either is fine"]},{"id":"free_times","label":"When are you usually free?","type":"multi_choice","options":["Weekday mornings","Weekday afternoons","Weekday evenings","Weekends"]},{"id":"not_emergency_ack","label":"I understand this form is not an emergency service","type":"checkbox","required":true,"help":"In a crisis, call your local emergency number or a crisis line."}]}'

JSON definition

json

{
  "title": "Starting therapy",
  "description": "Share what you feel comfortable sharing. You can say more in the first session. This form is not watched in real time and is not for emergencies.",
  "fields": [
    {
      "id": "client_name",
      "label": "Your name",
      "type": "short_text",
      "required": true,
      "max_length": 150
    },
    {
      "id": "preferred_name",
      "label": "Name you would like me to use",
      "type": "short_text",
      "max_length": 100
    },
    {
      "id": "client_phone",
      "label": "Phone",
      "type": "phone"
    },
    {
      "id": "client_email",
      "label": "Email",
      "type": "email",
      "required": true
    },
    {
      "id": "safe_to_message",
      "label": "How may I contact you?",
      "type": "single_choice",
      "required": true,
      "options": [
        "Voicemail is fine",
        "Text messages only",
        "Email only",
        "Please do not leave messages"
      ]
    },
    {
      "id": "therapy_for",
      "label": "Who is therapy for?",
      "type": "single_choice",
      "required": true,
      "options": [
        "Myself",
        "My partner and me",
        "My child or teen",
        "My family"
      ]
    },
    {
      "id": "reasons_for_therapy",
      "label": "What brings you to therapy?",
      "type": "multi_choice",
      "options": [
        "Anxiety",
        "Low mood",
        "Stress",
        "Relationship problems",
        "Grief or loss",
        "A big life change",
        "Past trauma",
        "Work or burnout",
        "I am not sure yet"
      ]
    },
    {
      "id": "change_wanted",
      "label": "What would you like to be different in a few months?",
      "type": "long_text",
      "max_length": 1500
    },
    {
      "id": "earlier_therapy",
      "label": "Have you had therapy before?",
      "type": "single_choice",
      "options": [
        "Never",
        "Yes, in the past",
        "I am in therapy now"
      ]
    },
    {
      "id": "support_around_you",
      "label": "Who supports you?",
      "type": "multi_choice",
      "options": [
        "Partner",
        "Family",
        "Friends",
        "A faith community",
        "Colleagues",
        "Not much support right now"
      ]
    },
    {
      "id": "session_format",
      "label": "How would you like to meet?",
      "type": "single_choice",
      "options": [
        "In person",
        "By video",
        "Either is fine"
      ]
    },
    {
      "id": "free_times",
      "label": "When are you usually free?",
      "type": "multi_choice",
      "options": [
        "Weekday mornings",
        "Weekday afternoons",
        "Weekday evenings",
        "Weekends"
      ]
    },
    {
      "id": "not_emergency_ack",
      "label": "I understand this form is not an emergency service",
      "type": "checkbox",
      "required": true,
      "help": "In a crisis, call your local emergency number or a crisis line."
    }
  ]
}

A therapy intake form for the first message