Client Intake Form

Client Intake Form Template for New Zealand

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Key Requirements PROMPT example:

"I need a Client Intake Form for my physiotherapy practice in Auckland, compliant with New Zealand healthcare regulations, that includes sections for ACC claims and detailed medical history collection."

Document background

The Client Intake Form is a crucial document used at the commencement of a service relationship in New Zealand. It serves as the primary tool for gathering essential client information, establishing service expectations, and ensuring compliance with legal requirements, particularly the Privacy Act 2020 and industry-specific regulations. This document is typically used when onboarding new clients and includes sections for personal details, service requirements, privacy consents, and other relevant information needed for service delivery. The form should be regularly reviewed and updated to maintain compliance with New Zealand legislation and best practices in data collection and privacy protection.

Suggested Sections

1. Personal Information: Basic contact details including full name, preferred name, date of birth, contact numbers, email, and postal address

2. Privacy Statement: Statement explaining how personal information will be collected, used, stored and shared, in compliance with the Privacy Act 2020

3. Emergency Contact Details: Name and contact information for emergency contact person

4. Service Requirements: Client's specific needs, requirements, and expectations from the service

5. Medical Information: Relevant health conditions, allergies, or medical requirements that may affect service delivery

6. Payment Information: Preferred payment methods and billing details

7. Consent and Declaration: Client's acknowledgment of terms, consent for data usage, and declaration of information accuracy

Optional Sections

1. Cultural Considerations: For capturing specific cultural needs or preferences, particularly relevant for services working with diverse communities

2. Accessibility Requirements: For clients who may need special accommodations or assistance

3. Insurance Details: When service requires or involves insurance coverage

4. AML/CFT Verification: For financial or regulated services requiring additional identity verification

5. Dietary Requirements: For services involving food or accommodation

6. Previous Service History: For capturing information about past experiences with similar services

Suggested Schedules

1. Identity Verification Documents: List of acceptable identification documents and copies of provided ID

2. Medical Certificates: Any relevant medical documentation if required for service provision

3. Service Terms and Conditions: Detailed terms and conditions of service provision

4. Privacy Policy: Detailed privacy policy and data protection information

5. Fee Schedule: Breakdown of service fees and payment terms if applicable

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

Professional Services

Legal Services

Financial Services

Education

Social Services

Wellness and Fitness

Hospitality

Consulting

Mental Health Services

Real Estate

Insurance

Childcare Services

Aged Care Services

Non-profit Organizations

Relevant Teams

Client Services

Operations

Administration

Compliance

Customer Support

Quality Assurance

Risk Management

Front Office

Business Development

Data Protection

Relevant Roles

Client Services Manager

Operations Director

Compliance Officer

Practice Manager

Administrative Assistant

Customer Service Representative

Intake Coordinator

Business Development Manager

Office Manager

Privacy Officer

Risk Manager

Service Coordinator

Operations Manager

Front Desk Coordinator

Quality Assurance Manager

Find the exact document you need

Simple Intake Form

A New Zealand-compliant intake form for collecting and managing client information, structured according to NZ privacy laws and business requirements.

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Let's create your Client Intake Form

Authors

Alex Denne

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