Initial Intake Form

Initial Intake Form Template for United Arab Emirates

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Key Requirements PROMPT example:

"I need an Initial Intake Form for my Dubai-based medical clinic that collects patient information, medical history, and insurance details, with Arabic translation options, to be implemented by March 2025."

Document background

The Initial Intake Form serves as a fundamental document for establishing new client relationships in the United Arab Emirates. It is designed to collect comprehensive information from individuals or organizations seeking services, while ensuring compliance with UAE Federal laws, particularly the Data Protection Law No. 45 of 2021 and relevant sector-specific regulations. This document is typically used at the commencement of a service relationship to gather essential information such as personal details, contact information, service requirements, and any specific needs or preferences. The form includes mandatory fields for UAE-specific information such as Emirates ID numbers and local contact details, making it particularly suited for use within the UAE jurisdiction. The Initial Intake Form can be customized for various sectors while maintaining its core structure and legal compliance requirements, serving as a crucial first step in client onboarding and service provision.

Suggested Sections

1. Personal Information: Basic identification details including full name (as per passport), Emirates ID number, passport number, date of birth, nationality, and contact information

2. Contact Details: Comprehensive contact information including residential address in UAE, permanent address (if different), email, phone numbers, and preferred method of contact

3. Emergency Contact Information: Details of primary and secondary emergency contacts including their relationship to the individual

4. Language Preferences: Preferred language for communication and whether an interpreter is needed

5. Documentation Checklist: List of required documents to be submitted with the form (Emirates ID copy, passport copy, etc.)

6. Declaration and Consent: Statement of information accuracy and consent for data processing in accordance with UAE Federal Decree Law No. 45 of 2021

Optional Sections

1. Medical History: For healthcare contexts - includes current medications, allergies, previous conditions, and family medical history

2. Employment Information: For business or employment contexts - includes current employer, position, work location, and employment status

3. Financial Information: For financial services contexts - includes income details, bank information, and financial obligations

4. Insurance Details: For healthcare or service contexts - includes insurance provider, policy number, and coverage details

5. Legal Status: For legal services contexts - includes visa status, residency details, and any relevant legal proceedings

6. Service-Specific Questions: Customized section based on the specific service or industry the form is being used for

Suggested Schedules

1. Schedule A - Required Documents Checklist: Detailed list of all required documents with submission instructions

2. Schedule B - Privacy Notice: Detailed explanation of how personal data will be collected, used, and protected in accordance with UAE law

3. Schedule C - Terms and Conditions: General terms and conditions for service provision and data handling

4. Appendix 1 - Supporting Documents Guide: Guide explaining how to prepare and submit required supporting documents

5. Appendix 2 - Fee Schedule: If applicable, breakdown of any associated fees or charges

6. Appendix 3 - Consent Forms: Additional specific consent forms that may be required based on service type

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Legal Services

Financial Services

Education

Real Estate

Professional Services

Insurance

Banking

Hospitality

Government Services

Corporate Services

Consulting

Relevant Teams

Customer Service

Client Relations

Administration

Compliance

Legal

Operations

Front Office

Patient Services

Onboarding

Registration

Data Management

Quality Assurance

Relevant Roles

Client Relations Manager

Intake Coordinator

Administrative Officer

Compliance Officer

Legal Assistant

Healthcare Administrator

Customer Service Representative

Operations Manager

Front Desk Manager

Account Manager

Patient Services Coordinator

Onboarding Specialist

Registration Officer

Practice Manager

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Authors

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