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Therapy Intake Form

Therapy Intake Form Template for Switzerland

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Key Requirements PROMPT example:

Therapy Intake Form

"I need a Therapy Intake Form for my new private psychology practice in Zurich opening in March 2025, with particular emphasis on trauma-informed care and both in-person and telehealth sessions."

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Document background
The Therapy Intake Form is a foundational document used at the commencement of therapeutic services in Switzerland. It serves multiple critical functions: gathering essential client information, establishing the therapeutic contract, ensuring regulatory compliance, and documenting informed consent. This document must adhere to Swiss federal and cantonal healthcare regulations, particularly regarding data protection (FADP/DSG) and medical records requirements. The form is typically completed before or during the first therapy session and includes sections for personal information, medical history, current concerns, emergency contacts, and various consents. It creates a legal record of the therapeutic relationship while providing healthcare providers with necessary information for effective treatment planning. The document is designed to be comprehensive yet accessible, ensuring all necessary information is collected while maintaining clarity for clients.
Suggested Sections

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

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

3. Insurance Information: Health insurance details, policy numbers, and coverage information

4. Current Health Status: Present physical and mental health conditions, medications, and treating physicians

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

6. Current Concerns: Primary reasons for seeking therapy and current symptoms or challenges

7. Privacy Notice: Information about how personal data is collected, stored, and protected in compliance with Swiss data protection laws

8. Consent for Treatment: Client's formal agreement to receive therapeutic services and acknowledgment of their rights and responsibilities

9. Financial Agreement: Payment terms, fees, cancellation policy, and insurance billing procedures

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

Optional Sections

1. Family History: Relevant family medical and mental health history - include when working with genetic or family-related concerns

2. Substance Use Assessment: Detailed questions about current and past substance use - include when relevant to treatment focus

3. Trauma History: Assessment of past traumatic experiences - include when trauma-focused therapy is indicated

4. Cultural Background: Information about cultural identity and preferences - include when cultural factors are significant for treatment

5. Electronic Communication Consent: Specific agreements for online therapy or electronic communications - include when offering telehealth services

6. Research Participation: Optional consent for anonymized data use in research - include when practice conducts research

7. Recording Consent: Permission to record sessions - include when recording might be used for training or supervision

Suggested Schedules

1. Privacy Policy: Detailed document explaining data protection measures and client rights under Swiss law

2. Fee Schedule: Comprehensive list of service fees and payment policies

3. Client Rights and Responsibilities: Detailed explanation of client's rights under Swiss healthcare laws and expected responsibilities

4. Treatment Modalities: Description of therapeutic approaches and methods used in practice

5. Office Policies: Detailed information about practice procedures, cancellation policies, and office protocols

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈË°æ | 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

Mental Health Services

Medical Practices

Psychology

Counseling Services

Healthcare Administration

Psychiatry

Social Services

Rehabilitation Services

Wellness and Prevention

Relevant Teams

Clinical Operations

Mental Health Services

Administrative Services

Compliance

Legal

Medical Records

Patient Services

Quality Assurance

Risk Management

Healthcare Operations

Relevant Roles

Psychotherapist

Clinical Psychologist

Psychiatrist

Mental Health Counselor

Practice Manager

Healthcare Administrator

Compliance Officer

Medical Records Manager

Privacy Officer

Clinical Director

Intake Coordinator

Mental Health Nurse

Occupational Therapist

Social Worker

Legal Counsel

Industries








Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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