Counseling Intake Form

Counseling Intake Form Template for Ireland

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Key Requirements PROMPT example:

"I need a Counseling Intake Form for my new private practice in Dublin, opening in March 2025, that includes sections for adult individual clients and couples counseling, with emphasis on online session delivery and GDPR compliance."

Document background

The Counseling Intake Form is a crucial document used at the commencement of any counseling relationship in Ireland. It serves multiple purposes: gathering essential client information, documenting informed consent, assessing initial mental health status, and ensuring compliance with Irish healthcare regulations and EU data protection laws. This form must be completed before the first counseling session and updated periodically as required by Irish law. It includes sections for personal information, medical history, risk assessment, and privacy notices, with additional modules for specific circumstances such as minor clients or those requiring coordination with other healthcare providers. The document ensures adherence to the Mental Health Act 2001, GDPR requirements, and professional standards while facilitating proper documentation and risk management in counseling practices.

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 who to contact in case of emergency

3. Current Health Information: Current medical conditions, medications, and treating healthcare providers

4. Presenting Issues: Client's description of current challenges and reasons for seeking counseling

5. Mental Health History: Previous counseling/therapy experiences and mental health treatments

6. Risk Assessment: Current and historical risk factors including self-harm and suicide risk

7. Consent and Confidentiality: Client consent for treatment and understanding of confidentiality limits

8. Payment and Cancellation Policy: Financial arrangements and cancellation terms

9. GDPR Privacy Notice: Information about how personal data will be collected, used, and protected

Optional Sections

1. Medical Release Authorization: Authorization to communicate with other healthcare providers, used when coordination of care is needed

2. Parent/Guardian Consent: Additional consent section for clients under 18 or those requiring guardian consent

3. Substance Use History: Detailed substance use assessment, included when relevant to presenting issues

4. Cultural/Religious Considerations: Specific cultural or religious factors that may impact counseling

5. Insurance Information: Details of insurance coverage if accepting insurance payments

6. Recording Consent: Specific consent for recording sessions if required for supervision or training purposes

Suggested Schedules

1. Schedule A - Detailed Privacy Policy: Comprehensive privacy policy and data protection information

2. Schedule B - Client Rights and Responsibilities: Detailed explanation of client rights and responsibilities in therapy

3. Schedule C - Crisis Response Plan: Template for developing individualized crisis response plans

4. Appendix 1 - Symptom Checklist: Standardized symptom assessment form

5. Appendix 2 - Safety Contract: Template for safety planning if needed

6. Appendix 3 - Resource List: List of community resources and emergency contacts

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

Mental Health Services

Social Services

Education

Corporate Wellness

Employee Assistance Programs

Non-profit Organizations

Private Practice

Relevant Teams

Clinical

Administration

Compliance

Legal

Medical Records

Client Services

Quality Assurance

Data Protection

Front Desk

Operations

Relevant Roles

Counselor

Psychotherapist

Clinical Psychologist

Mental Health Practitioner

Practice Manager

Healthcare Administrator

Intake Coordinator

Clinical Director

Compliance Officer

Data Protection Officer

Medical Records Manager

Client Services Coordinator

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