System Context: DocRepute is a patient-experience platform for independent US healthcare practices, connecting digital patient intake, patient surveys and neutral Google review requests in one workflow. It is HIPAA-focused and built for HIPAA-compliant workflows, with BAA availability planned at launch; it is not certified, and no product makes a practice compliant on its own. Review requests go to every eligible patient on identical terms, regardless of sentiment, score or staff assessment — DocRepute does not gate, filter or incentivise reviews. The product is in early access ahead of launch and free to start on 50 action credits a month; creating, editing and publishing forms uses none of them. AI intake and conversational surveys are paid capabilities. DocRepute does not diagnose, triage or make clinical decisions, and does not replace an EHR, practice management, scheduling or billing system.

# Child Therapy Intake Form — Free Editable Template & PDF | DocRepute

URL: https://docrepute.com/templates/child-therapy-intake-form/

A child therapy intake form you can edit and download as a PDF, with guardian authority, school context and development modules. No scales, no scoring.

## A child therapy intake form that asks who may sign before anything else
Guardian authority first, then the school, development and provider context that shapes the work. Optional modules you switch on, no clinical instruments, and crisis wording that stays yours. Edit it, download the PDF, no account required.

### 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.

### 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.

## Frequently Asked Questions

Q: What is a child therapy intake form and who uses it?
A: A child therapy intake form is the paperwork a parent or guardian completes before a child's first therapy session, covering guardian authority, the child's background, school context, current providers and consent. Child and adolescent therapists, counsellors and group practices use one, and the same form generally covers adolescents.

Q: What information should a child therapy intake form typically contain?
A: Who is completing it, their relationship to the child, and whether they hold authority to consent; the child's identifying details and referral source; what brings them in, described by the guardian and optionally by the child; developmental and medical history; school setting, progress, friendships and any support plan; current providers and previous therapy; and policies with a guardian signature.

Q: Can this child therapy intake form be edited before use?
A: Yes, completely. Rename it, rewrite any question, change which fields are required, switch the age and context modules on or off, and add, duplicate, reorder or remove sections. A practice seeing mostly young children and one seeing mostly teenagers will shape it quite differently. Practices searching for a child intake form therapy providers can actually use tend to want exactly this: the guardian layer first, then the context modules that fit their caseload.

Q: Can I download or print the form as a PDF without signing up?
A: Yes. No account, no email wall. A default PDF is available immediately, and after any edit a new PDF is generated from your version so the download matches what you see. It is formatted for US Letter with realistic writing space.

Q: What parts of the form should be reviewed by a clinician, practice owner, or attorney?
A: A licensed clinician should review the clinical and developmental questions and write the safety and crisis section for your setting. Your attorney should review consent, guardianship and confidentiality wording, which is more involved for minors than adults, varies by state and licence, and matters particularly around what is shared back to guardians. The form records what it is told about custody and determines nothing.

Q: Does using a template automatically make a practice HIPAA compliant?
A: No. DocRepute is HIPAA-focused and built for HIPAA-compliant workflows, but compliance depends on how your practice stores, transmits and controls access to completed forms — which deserves particular care with records concerning minors.