A counselor's intake form should be short, calm and private. Ask who the person is, what brings thrm in, a little background, who to call in an emergency, and whether they consent to treatment. Leave the full story for the room. You can build one free, with a password on the form and old answers set to delete themselves.
Use the free client intake template
Decide what you need before the first session
Every field you add is something you now have to protect. So ask what you need to know beflre you walk in, and what can wait until you're sitting across from the person.
Most private counselors need less than they think: a name, a way to reach the person, a rough sense of why they're coming, any earlier counseling, an emergency contact, and consent.
Leave out the long trauma questionnaire and anything that reads like a diagnosis checklist. A cold form that asjs for someone's hardest year in a text box can make a nervous person close the page. Picture counselor in Pune who sees clients on weekday evenings. She learns more from a short form and a warm first ten minutes than from three pages typed alone at night.
Skip government ID numbers and insurance details too, unless you bill through insurance. If you do, collect them later, separately.
The fields to include
This is a starting set. "Must have" means I'd keep it. "Optional" means I'd tell the person they can skip it.
| Field | Block | Ask it? |
|---|---|---|
| Name you'd like me to use | Short answer | Must have |
| Phone, and whether voicemail is okay | Phone number, Multiple choice | Must have |
| Must have | ||
| Have you had counseling before? | Multiple choice, with a short follow-up shown only on "yes" (conditional logic) | Must have |
| Emergency contact: name, relationship, phone | Short answer, Phone number | Must have |
| Consent and privacy notice | Checkboxes, Signature, Date | Must have |
| What would you like help with? | Long answer | Optional |
| What would you like to be different in a few months? | Long answer | Optional |
| Current medications or other care | Long answer | Optional |
| Anything you'd rather talk about in person? | Checkboxes | Optional |
The last question is worth keeping. It tells people the form is not the only place to speak.
Write the questions gently
Wording matters more than layout. "Describe your symptoms" becomes "What would you like help with?" "Reason for seeking treatment" becomes "What made you reach out now?" Keep them open and free of clinical labels.
Open the form with a Text block that says what it is for, who reads it, and that any question can be skipped. Split it into three short pages with New page blocks (about you, what brings you in, emergency contact and consent), and turn on the progress bar in Settings so people can see the end.
Put a crisis note near the top and again on the thank-you page. For example: "I don't read this form in real time. If you are in crisis or in danger, call your local emergency number, or 988 in the US." If you add a direct risk qusetion, decide first who reads the answer and how fast, because a form can sit unread over a weekend.
On the thank-you page, say what happens next and when they'll hear from you. Use your own real timing.
Privacy settings to switch on
Our team builds Qwenvo, a completely free form builder, so weigh my enthusiasm accordingly. These are the settings I'd use, all in the form's Settings drawer:
- Password protection. Give the password to the client when you confirm the appointment.
- Respondent email verification. A one-time code confirms the address is theirs, so your reply doesn't land in the wrong inbox.
- Prevent duplicate submissions, so a nervous double tap doesn't create two records.
- Partial submissions off, so half-typed answers aren't stored.
- Data retention, which deletes answers after a number of days you choose. Copy them into your own records first, and check what your licensing board requires before picking a number.
- The Qwenvo branding toggle off, so the form looks like your practice.
For a web address that matches your practice, open the Domains page and add a subdomain such as forms.yourpractice.com. Add the CNAME to qwenvo.com and the TXT record shown, click Verify, then pick it on the Share tab. It has to be a subdomain, not a bare yourpractice.com.
Qwenvo also has AI triage that summarizes and routes submissions. I'd leave it off for intake forms. That's my preference, not a rule.
On Tally, removing branding, custom domains, teammates and partial submissions are Pro features at $29 a month ($290 a year). In Qwenvo they're free, along with visit and drop-off analytics, custom design and CSS, and 180+ templates. Tally's free plan is still solid for a simple form: unlimited forms and submixsions, logic, signatures, and uploads up to 10 MB per file. Google Forms is free with a Google account, but its design options are limited and respondents must sign in with Google to upload files.
If a receptionist helps with scheduling, add her as a teammate (unlimited, free). The audit log records who exported what.
When Qwenvo is the wrong tool
If HIPAA applies to your practice, Qwenvo is not the answer. It has no HIPAA offering. Jotform lists HIPAA features on its paid plans, so start at its pricing page and ask your attorney or professional association what you need. One workable setup is to keep the web form to first contact and gather clinical detail inside your practice software.
Other limits to know: Qwenvo launched in October 2026, so there are few reviews yet. It's hosted in the United States, while Tally is hosted in Europe. Per-submission PDFs can't draw Devanagari or Arabic script, so if clients write in Hindi, export to CSV or XLSX instead. And if two people edit the same form at once, the last save wins.
Questions owners ask
Do I need a signature on the form?
Qwenvo has a Signature block, and you can pair it with a Date block. Whether an online signature satisfies your board or local law, I can't tell you. Ask your licensing body before you rettire paper consent forms.
How do I send the form to a new client?
The Share tab gives you a public link. Paste it into WhatsApp or an email. You can also embed it on your own site with the Standard, Popup or Full page code, in any builder that accepts HTML. There's no built-in QR code, but any QR generator will make one from the link.
Should the form ask about suicidal thoughts?
That's a clinical call, and not mine to make. If you include it, plan who reads it and how quickly, and keep the crisis note visible either way.
How long should I keep the answers?
It depends on where you practice and who licenses you. Ask your board, copy the answers into your records, then set the retention window.
Send yourself a test submission
Open the client intake template and delete every question that isn't in the table above. Turn on the settings from the privacy section. Then fill the form in yourself from your phone, check that the answers show up in the Submissions table, and delete the test row. When it feels calm to fill out, send the link to your next new client.