A child therapy intake form that asks who may sign before anything else

Built for a form an adult completes about a child

A child therapy intake form has a structural difference from every other intake document: the person filling it in is not the client. That changes who signs, what may be shared with whom, and how each answer should be read. Most child counseling intake form templates online are an adult therapy form with an age field added, and they leave the practice to work out the rest. This preset starts from the guardian relationship and builds outward. It is editable throughout, the PDF is available immediately, and there is no signup and no email wall between you and a document you are about to hand to a parent who is probably already anxious.

• Built for HIPAA-compliant workflows

• Free to start — 50 patient actions each month

Guardian authority, asked rather than assumed

The first section establishes who is completing the form, their relationship to the child, and whether they have the authority to consent to treatment — a question worth asking directly rather than inferring from whoever booked the appointment. Where parents are separated, the form records the arrangement as the guardian describes it and captures who else may be contacted, who may collect the child, and who should receive communication about sessions. What the form deliberately does not do is decide anything about custody. It records what it is told and leaves any determination to the documents and authorities that actually govern it, which is the only defensible position for a template — and, practically, the position that keeps a practice out of the middle of a dispute.

What a child and adolescent intake form usually covers

Beyond guardian details: the child's identifying information, who referred them, and what brings them in described by the guardian, with a separate space for the child's own words where the practice wants it. Developmental history at whatever depth your practice needs — pregnancy and birth, milestones, medical history, sleep and appetite. The school picture, which for children is often the richest source of information: setting, year group, academic progress, friendships, any support plan already in place, and whether the school has raised concerns. Current providers, including paediatrician, any other therapists and prescribers. Previous therapy and how the child found it. Then policies and consent, signed by the guardian with authority to give it. Age and context modules are optional, so a practice seeing mostly under-eights and one seeing mostly teenagers can each switch on what fits.

Edit it in plain language, download exactly what you built

Rename the form, rewrite any question or helper text, mark fields required or optional, switch the optional modules on or off, and add, duplicate, reorder or remove sections. Wording carries weight here — a guardian reading a cold form about their child notices, and softening a question costs nothing. A default PDF is ready as soon as the page loads, and after any change a new PDF is generated from your current version, so what downloads matches what is on screen. It prints on US Letter with clean page breaks and real writing space, and reset restores the original preset.

A practice seeing school-age children, one afternoon

A therapist whose caseload is mostly seven to twelve year olds starts from this preset. She makes the consent-authority question required after a session was nearly held on the word of a grandparent who turned out not to hold it. She expands the school section, since teachers are the source of most of her useful information, and adds a line asking whether the school may be contacted and by whom. She adds a short space for the child to write or draw what they hope will be different, which parents tell her their children take seriously. She writes her own paragraph on what she shares back to guardians and what she keeps between herself and the child, which for this age group is the question families ask first. Her attorney reviews it for her state. One afternoon, well spent.

No scales, no scoring, and your crisis wording

The form records what a guardian and, where appropriate, a child chooses to report. It contains no clinical instrument, reproduces no published scale, scores nothing, assesses no risk of suicide or violence, triages no urgency, suggests no diagnosis and offers no advice about treatment — those are the work of a licensed clinician who has met the child, and an intake form that reached for them would be both unsafe and unhelpful. Safety and crisis process is a section your practice writes and owns, with the contacts and escalation steps your setting and jurisdiction require. Because this is a public builder, nothing you type here is sent to analytics, and you should build the blank form here rather than entering a real child’s details. Have a licensed clinician review the clinical and developmental questions for your caseload, and your attorney review consent, guardianship and confidentiality wording, which is more involved for minors than for adults and varies by state and licence type.