Therapy Intake Form

Therapy Intake Form Template for Australia

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Key Requirements PROMPT example:

"I need a Therapy Intake Form for my new psychology practice opening in March 2025 in Sydney, focusing on adolescent clients and including both telehealth and in-person sessions, with Medicare billing options."

Document background

The Therapy Intake Form is a crucial document used at the commencement of therapeutic services in Australia. It serves multiple purposes: gathering essential client information, documenting informed consent, establishing the therapeutic framework, and ensuring compliance with Australian healthcare and privacy regulations. This document is typically completed before or during the initial consultation and includes sections for personal information, medical history, emergency contacts, and consent for treatment. The form must comply with the Privacy Act 1988 (Cth), relevant state health records legislation, and professional practice standards. It provides the foundation for the therapeutic relationship while protecting both the practitioner and client through clear documentation of policies, procedures, and mutual expectations.

Suggested Sections

1. Personal Information: Basic client details including name, date of birth, contact information, and preferred contact method

2. Emergency Contact Information: Details of primary and secondary emergency contacts

3. Current Health Status: Present mental and physical health conditions, medications, and treating healthcare providers

4. Medical History: Relevant past medical conditions, hospitalizations, and treatments

5. Privacy and Confidentiality Statement: Explanation of privacy policies, data handling, and limits of confidentiality

6. Consent for Treatment: Client's informed consent for therapeutic services and acknowledgment of understanding

7. Payment and Cancellation Policy: Fee structure, payment terms, and cancellation/missed appointment policies

8. Client Rights and Responsibilities: Overview of client's rights in therapy and expected responsibilities

9. Crisis Protocol: Procedures for emergency situations and after-hours support

Optional Sections

1. Insurance Information: Details of private health insurance if applicable for claiming purposes

2. Telehealth Consent: Additional consent and protocols for online therapy sessions if offering telehealth services

3. Cultural Background: Information about cultural identity and preferences to ensure culturally appropriate care

4. Relationship Status: Details about relationship status and living situation if relevant to treatment

5. Previous Therapy Experience: Information about past therapeutic experiences and what worked/didn't work

6. Substance Use Assessment: Details about current and past substance use if relevant to treatment focus

7. Family Mental Health History: Information about family history of mental health conditions if relevant

Suggested Schedules

1. Schedule A - Practice Policies: Detailed outline of practice policies including communications, social media, and professional boundaries

2. Schedule B - Fee Schedule: Comprehensive breakdown of all possible fees and charges

3. Schedule C - Privacy Policy: Detailed privacy policy including information handling, storage, and third-party disclosures

4. Schedule D - Crisis Resources: List of emergency contacts and crisis support services

5. Appendix 1 - Mental Health Care Plan Information: Information about Mental Health Care Plans and Medicare rebates if applicable

6. Appendix 2 - Client Rights Charter: Detailed explanation of client rights in therapy based on Australian healthcare standards

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

Mental Health

Allied Health

Healthcare Services

Psychology

Counseling

Social Work

Occupational Therapy

Private Practice

Community Health

Telehealth Services

Relevant Teams

Clinical Operations

Administration

Legal & Compliance

Patient Services

Quality Assurance

Healthcare Records

Front Desk

Practice Management

Relevant Roles

Psychologist

Counselor

Mental Health Social Worker

Occupational Therapist

Practice Manager

Clinical Director

Intake Coordinator

Administrative Assistant

Compliance Officer

Healthcare Legal Advisor

Privacy Officer

Mental Health Nurse

Clinical Psychologist

Family Therapist

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