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Client Intake Form

Client Intake Form Template for Ireland

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Key Requirements PROMPT example:

Client Intake Form

"I need a Client Intake Form for my Dublin-based psychological counseling practice, compliant with Irish healthcare regulations and GDPR, that includes sections for mental health history and emergency contact information, to be implemented by March 2025."

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Document background
The Client Intake Form is a crucial document used at the commencement of any client relationship in Ireland. It serves as the primary tool for gathering essential information about new clients while ensuring compliance with Irish and EU regulatory requirements, including GDPR, the Data Protection Act 2018, and relevant consumer protection legislation. This form is designed to capture all necessary client details, consent declarations, and service requirements in a structured manner that satisfies legal obligations while establishing clear expectations for the service relationship. The document is particularly important for maintaining proper records and demonstrating compliance with anti-money laundering regulations and data protection requirements. Organizations across various sectors use this Client Intake Form to standardize their client onboarding process and ensure all regulatory requirements are met from the outset of the client relationship.
Suggested Sections

1. Client Personal Information: Basic identification details including full name, date of birth, contact information, and preferred communication methods

2. Address and Contact Details: Current residential address, correspondence address if different, emergency contact information

3. Identity Verification: Details of identification documents provided to comply with AML requirements

4. Service Requirements: Primary reason for seeking services, immediate needs, and expected outcomes

5. Financial Information: Basic financial information relevant to service provision

6. Data Protection Notice: GDPR-compliant explanation of how personal data will be collected, used, and stored

7. Consent Declarations: Client authorizations for data processing, communication preferences, and service delivery

8. Terms and Conditions: Basic terms of service engagement and client-provider relationship

9. Signature and Date: Space for client signature, date, and witness signature if required

Optional Sections

1. Business Entity Information: For business clients: company registration details, corporate structure, and authorized representatives

2. Additional Service Requirements: For complex cases: detailed description of additional services or specific requirements

3. Medical Information: For health-related services: relevant medical history and current health conditions

4. Income and Employment: For financial services: detailed employment history and income information

5. Third Party Authorization: When client wishes to authorize others to act on their behalf

6. Special Accommodations: For clients requiring specific accommodations or assistance

7. Previous Service History: For returning clients or those with relevant service history with other providers

Suggested Schedules

1. Schedule A - Service Fee Schedule: Detailed breakdown of applicable fees and payment terms

2. Schedule B - Required Documentation Checklist: List of documents client needs to provide for complete registration

3. Schedule C - Privacy Policy: Detailed privacy policy and data protection information

4. Appendix 1 - Consent Forms: Additional specific consent forms required for particular services

5. Appendix 2 - Terms of Service: Detailed terms and conditions of service provision

6. Appendix 3 - Client Rights and Responsibilities: Detailed explanation of client rights and responsibilities during service provision

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

Legal Services

Financial Services

Healthcare

Professional Services

Consulting

Real Estate

Insurance

Education

Social Services

Business Services

Accounting

Technology Services

Nonprofit Organizations

Relevant Teams

Client Services

Legal

Compliance

Operations

Administration

Customer Relations

Risk Management

Data Protection

Business Development

Client Onboarding

Account Management

Relevant Roles

Client Services Manager

Compliance Officer

Legal Counsel

Operations Manager

Customer Relations Representative

Administrative Assistant

Office Manager

Intake Coordinator

Business Development Manager

Risk Manager

Data Protection Officer

Practice Manager

Client Onboarding Specialist

Account Manager

Service Coordinator

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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