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Corporation Corp.
‍ Acme LLC.

Corporation Corp.

Acme LLC.

Corporation Corp.

Therapist Intake Form

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Date: March 8th 2023



Acme LLC.

Corporation Corp.

This Contract is between Client (the "Client") and Acme LLC, a California limited liability company (the "Coach").

The Contract is dated January 23, 2023.


1.1 Project. The Client is hiring the Coach to develop a coaching relationship between the Client and Coach in order to cultivate the Client's personal, professional, or business goals and create a plan to achieve those goals through stimulating and creative interactions with the ultimate result of maximizing the Client's personal or professional potential.

1.2 Schedule. The Coach will begin work on February 1, 2023 and will continue until the work is completed. This Contract can be ended by either Client or Coach at any time, pursuant to the terms of Section 4, Term and Termination.

The Coach and Client will meet by video conference, 4 days per month for 2 hours.

1.3 Payment. The Client will pay the Coach an hourly rate of $150. Of this, the Client will pay the Coach $500.00 (USD) before work begins.

1.4 Expenses. The Client will reimburse the Coach's expenses. Expenses do not need to be pre-approved by the Client.

1.5 Invoices. The Coach will invoice the Client in accordance with the milestones in Section 1.3. The Client agrees to pay the amount owed within 15 days of receiving the invoice. Payment after that date will incur a late fee of 1.0% per month on the outstanding amount.

1.6 Support. The Coach will not be available by telephone, or email in between scheduled sessions.


- A coaching relationship is a partnership between two or more individuals or entities, like a teacher-student or coach-athlete relationship. Both the Client and Coach must uphold their obligations for the relationship to be successful.

- The Coach agrees to maintain the ethics and standards of behavior established by the International Coaching Federation (ICF).

- The Client acknowledges and agrees that coaching is a comprehensive process that may explore different areas of the Client's life, including work, finances, health, and relationships.

- The Client is responsible for implementing the insights and techniques learned from the Coach.


3.1 Overview. This section contains important promises between the parties.

3.2 Authority To Sign. Each party promises to the other party that it has the authority to enter into this Contract and to perform all of its obligations under this Contract.

3.3 Coach Has Right To Give Client Work Product. The Coach promises that it owns the work product, that the Coach is able to give the work product to the Client, and that no other party will claim that it owns the work product. If the Coach uses employees or subcontractors, the Coach also promises that these employees and subcontractors have signed contracts with the Coach giving the Coach any rights that the employees or subcontractors have related to the Coach's background IP and work product.

3.4 Coach Will Comply With Laws. The Coach promises that the manner it does this job, its work product, and any background IP it uses comply with applicable U.S. and foreign laws and regulations.

3.5 Work Product Does Not Infringe. The Coach promises that its work product does not and will not infringe on someone else's intellectual property rights, that the Coach has the right to let the Client use the background IP, and that this Contract does not and will not violate any contract that the Coach has entered into or will enter into with someone else.

3.7 Client-Supplied Material Does Not Infringe. If the Client provides the Coach with material to incorporate into the work product, the Client promises that this material does not infringe on someone else's intellectual property rights.


This Contract is ongoing until it expires or the work is completed. Either party may end this Contract for any reason by sending an email or letter to the other party, informing the recipient that the sender is ending the Contract and that the Contract will end in 7 days. The Contract officially ends once that time has passed. The party that is ending the Contract must provide notice by taking the steps explained in Section 9.4. The Coach must immediately stop working as soon as it receives this notice unless the notice says otherwise.

If either party ends this Contract before the Contract automatically ends, the Client will pay the Contractor for the work done up until when the Contract ends. The following sections don't end even after the Contract ends: 3 (Representations); 6 (Confidential Information); 7 (Limitation of Liability); 8 (Indemnity); and 9 (General).


The Client is hiring the Coach as an independent contractor. The following statements accurately reflect their relationship:

- The Coach will use its own equipment, tools, and material to do the work.

- The Client will not control how the job is performed on a day-to-day basis. Rather, the Coach is responsible for determining when, where, and how it will carry out the work.

- The Client will not provide the Coach with any training.

- The Client and the Coach do not have a partnership or employer-employee relationship.

- The Coach cannot enter into contracts, make promises, or act on behalf of the Client.

- The Coach is not entitled to the Client's benefits (e.g., group insurance, retirement benefits, retirement plans, vacation days).

- The Coach is responsible for its own taxes.

- The Client will not withhold social security and Medicare taxes or make payments for disability insurance, unemployment insurance, or workers compensation for the Coach or any of the Coach's employees or subcontractors.


6.1 Overview. This Contract imposes special restrictions on how the Client and the Coach must handle confidential information. These obligations are explained in this section.

6.2 The Client's Confidential Information. While working for the Client, the Coach may come across, or be given, Client information that is confidential. This is information like customer lists, business strategies, research & development notes, statistics about a website, and other information that is private. The Coach promises to treat this information as if it is the Coach's own confidential information. The Coach may use this information to do its job under this Contract, but not for anything else. For example, if the Client lets the Coach use a customer list to send out a newsletter, the Coach cannot use those email addresses for any other purpose. The one exception to this is if the Client gives the Coach written permission to use the information for another purpose, the Coach may use the information for that purpose, as well. When this Contract ends, the Coach must give back or destroy all confidential information, and confirm that it has done so. The Coach promises that it will not share confidential information with a third party, unless the Client gives the Coach written permission first. The Coach must continue to follow these obligations, even after the Contract ends. The Coach's responsibilities only stop if the Coach can show any of the following: (i) that the information was already public when the Coach came across it; (ii) the information became public after the Coach came across it, but not because of anything the Coach did or didn't do; (iii) the Coach already knew the information when the Coach came across it and the Coach didn't have any obligation to keep it secret; (iv) a third party provided the Coach with the information without requiring that the Coach keep it a secret; or (v) the Coach created the information on its own, without using anything belonging to the Client.

6.3 Third-Party Confidential Information. It's possible the Client and the Coach each have access to confidential information that belongs to third parties. The Client and the Coach each promise that it will not share with the other party confidential information that belongs to third parties, unless it is allowed to do so. If the Client or the Coach is allowed to share confidential information with the other party and does so, the sharing party promises to tell the other party in writing of any special restrictions regarding that information.


Neither party is liable for breach-of-contract damages that the breaching party could not reasonably have foreseen when it entered this Contract.


8.1 Overview. This section transfers certain risks between the parties if a third party sues or goes after the Client or the Coach or both. For example, if the Client gets sued for something that the Coach did, then the Coach may promise to come to the Client's defense or to reimburse the Client for any losses.

8.2 Client Indemnity. In this Contract, the Coach agrees to indemnify the Client (and its affiliates and their directors, officers, employees, and agents) from and against all liabilities, losses, damages, and expenses (including reasonable attorneys' fees) related to a third-party claim or proceeding arising out of: (i) the work the Coach has done under this Contract; (ii) a breach by the Coach of its obligations under this Contract; or (iii) a breach by the Coach of the promises it is making in Section 3 (Representations).

8.3 Coach Indemnity. In this Contract, the Client agrees to indemnify the Coach (and its affiliates and their directors, officers, employees, and agents) from and against liabilities, losses, damages, and expenses (including reasonable attorneys' fees) related to a third-party claim or proceeding arising out of a breach by the Client of its obligations under this Contract.


9.1 Assignment​. This Contract applies only to the Client and the Coach. Neither the Client nor the Coach can assign its rights or delegate its obligations under this Contract to a third-party (other than by will or intestate), without first receiving the other's written permission.

9.2 Arbitration. As the exclusive means of initiating adversarial proceedings to resolve any dispute arising under this Contract, a party may demand that the dispute be resolved by arbitration administered by the American Arbitration Association in accordance with its commercial arbitration rules.

9.3 Modification; Waiver. To change anything in this Contract, the Client and the Coach must agree to that change in writing and sign a document showing their contract. Neither party can waive its rights under this Contract or release the other party from its obligations under this Contract, unless the waiving party acknowledges it is doing so in writing and signs a document that says so.

9.4. Noticies.

(a) Over the course of this Contract, one party may need to send a notice to the other party. For the notice to be valid, it must be in writing and delivered in one of the following ways: personal delivery, email, or certified or registered mail (postage prepaid, return receipt requested). The notice must be delivered to the party's address listed at the end of this Contract or to another address that the party has provided in writing as an appropriate address to receive notice.

(b) The timing of when a notice is received can be very important. To avoid confusion, a valid notice is considered received as follows: (i) if delivered personally, it is considered received immediately; (ii) if delivered by email, it is considered received upon acknowledgement of receipt; (iii) if delivered by registered or certified mail (postage prepaid, return receipt requested), it is considered received upon receipt as indicated by the date on the signed receipt. If a party refuses to accept notice or if notice cannot be delivered because of a change in address for which no notice was given, then it is considered received when the notice is rejected or unable to be delivered. If the notice is received after 5:00pm on a business day at the location specified in the address for that party, or on a day that is not a business day, then the notice is considered received at 9:00am on the next business day.

9.5 Severability. This section deals with what happens if a portion of the Contract is found to be unenforceable. If that's the case, the unenforceable portion will be changed to the minimum extent necessary to make it enforceable, unless that change is not permitted by law, in which case the portion will be disregarded. If any portion of the Contract is changed or disregarded because it is unenforceable, the rest of the Contract is still enforceable.

9.6 Signatures. The Client and the Coach must sign this document using Bonsai's e-signing system. These electronic signatures count as originals for all purposes.

9.7 Governing Law. The validity, interpretation, construction and performance of this document shall be governed by the laws of the United States of America.

9.8 Entire Contract. This Contract represents the parties' final and complete understanding of this job and the subject matter discussed in this Contract. This Contract supersedes all other contracts (both written and oral) between the parties.



Acme LLC.

Corporation Corp.
Table of contents

Therapy intake sessions are more than just gathering information. They also help your clients form an initial impression of your practice by demonstrating your listening skills, level of organization, and therapeutic orientation. One of the best things you can do for your therapy practice is to get intake right since it gets your work going in the proper direction. Of course, doing it correctly is easier said than done.

During the first sessions, empathic listening and information collection must coexist in a delicate balance, not to mention describing your practice to your client. For this reason, implementing a therapist intake form before you even meet the patient is a great tool to gather information in advance and be better prepared for the intake session. To help you create the perfect intake form, we will go over some of the main aspects you must cover.

But first, let's further look into the benefits of implementing this client form into your intake process.

Note: With Bonsai, you can quickly create professional online forms and have all of your paperwork ready when you need it. We help you boost client intake and lead capture with questionnaires that fit your workflow! You'll also get access to our contract and invoice templates for therapists. Try a 14-day free trial today.

Why Client Forms Are Vital for Your Intake Process

The first step on the road to better mental health for people seeking therapy is the intake process. When done correctly, this is an excellent way to find out crucial facts regarding the patient before beginning the therapeutic process. In addition to providing information on the client's background and current life transitions, intake forms propose a structure for the first appointment and a potential path to follow moving forward.

Early on, gaining a thorough understanding of the client can save time and increase the client's trust and confidence in the counseling process. Gathering this information otherwise might take up too much time in sessions, risking losing the client's early motivation to seek care. This way, you have the opportunity to formulate follow-up questions to ask during the intake session that help you gain a better insight into your patient's needs and mental health history.

Essential Elements to Include in Your Therapist Intake Forms

When creating your client intake form, keep in mind the ultimate goal is not only to gather the client's basic information, but to discover their drivers for seeking counseling, goals, and expectations of the therapeutic relationship. You also want to make sure you are an appropriate match and you will be able to provide the help that your patient needs.

While the specific questions you choose may vary depending on your niche, there are some essential elements you must not miss in order to collect all the information you need. Let's take a closer look at these vital elements so you can get a better idea of how to dig deeper and create a comprehensive, yet straightforward intake form.

Basic Contact Information

The first section of your intake form should help you gather the patient's basic contact details and any other relevant information for your practice (referrals, insurance information, etc....) Here are some of the basic details patients are often asked to fill out.

- Full name

- Date of birth

- Phone number and email address

- Physical/billing address

- Medical ID

- Emergency contact

- Insurance company information

- Preferred method of communication


In order for you to ensure the services you provide are appropriate for the potential client, you must include a set of questions to understand why they are looking for therapy and what they expect to get out of it. Here are some of the most popular questions an intake form includes.

- What is the main reason why you are seeking help?

- Have you ever sought therapy before? If yes, how was the experience?

- If anything was possible, what beneficial changes would you make to your life right now?

- What outcomes are you hoping for from therapy? How will you know when you're prepared to end?

- Are there any recent changes in your life that I should be aware of?

- What methods have you already tried to address the issue?

Medical History

Asking your patient to be honest about their medical history before starting therapy with you, will allow you to provide them with the best diagnosis and treatment plan. Try to learn as much as you can about their health, family history and any additional information you consider appropriate. These are some of the most common aspects addressed regarding a patient's medical background.

- Current medications

- Existing medical conditions

- Specific signs and symptoms in the body, mind, and behavior

- Family members who have had mental illness in the past and their diagnoses

- Abuse or trauma history (physical, sexual or emotional)

- Previous mental health diagnosis, substance abuse history and treatment

Informed Consent

Your client intake form can also include an informed consent notice, although many present this as a separate form, however still part of the intake process. Informed consent is the process of providing information about the dangers, advantages, and anticipated outcomes of your therapy approach to the patient in order for them to make an informed decision about working with you. Different states have different laws governing informed consent, and many of them specify the information that informed consent forms must include.

Create the Perfect Client Intake Form With Bonsai

Ready to draft the perfect therapist intake form? Do it right, with Bonsai's client form builder. Our forms are fully customizable so you can include as many questions as you like, select the answer format that you prefer and even add your own branding elements to make it unique. Once you are done modifying your intake form you can send it as an online document directly to your clients via email or URL link. Additionally, you can have it embedded into your business website which is incredibly helpful to collect leads and get more clients.

Bonsai is the best way to create professional documents and keep your paperwork organized. Furthermore, we offer a full range of administrative tools to help you streamline your processes from client onboarding to invoicing, payment processing, accounting and much more. Discover all of these amazing features with your 14-day free trial, and join the thousands of independent professionals already reaping these benefits!

Frequently Asked Questions

Questions about this template.

How do you create a client intake form?

Sign up with Bonsai and try our form building software. Easily design professional therapist client intake forms by using our template today. Claim your 14-day free trial here.

How do therapists take intake?

A therapist does an intake by asking questions while actively listening. Let your client know that it's OK to feel anxious or frightened before a session. Ask them what motivated them to seek treatment, but also what they want to gain from it

How do I create an intake in Google Docs?

You can create an intake form on Google Doc, or try the much simpler software Bonsai. Our form builder makes it incredibly easy to design, download and send intake forms to new clients.