Clinical Intake Forms for New Clients

There are several standard clinical intake forms that we ask each new client to complete:

  1. Contact Information Form. This form provides us with your contact information and allows you to specify how you would like to be contacted in the future by Cobb & Associates.

  2. Informed Consent and Authorization for Services Form. This form summarizes important information about confidentiality, fees, cancellation policies, and other practices and policies of Cobb & Associates. Please review it, initial where necessary, and sign page 4.

  3. Intake questionnaire. The purpose of this questionnaire is to aid assessment and treatment planning by giving your therapist a broad overview of your background and current situation at a glance. All information you provide in this form will be kept as part of your confidential file.

It should take about 10 minutes to complete these forms. So that we can spend your session time focusing on your concerns and not paperwork, we prefer to have you fill them out ahead of time, before the start of the first session. If you are coming as a couple, each spouse should fill out the complete package listed above.

Clicking on a link below will open a PDF version of these forms in a separate window. Then you can print the forms directly to your printer, complete them at home, and bring them with you to the first appointment.

Click on a Link Below to Download Intake Forms

Please select one of the three categories below that most pertains to your situation and click on the link in that box to open the intake forms.

General Intake Package - New Client Forms

Use these forms if you are coming for individual counselling or couples counselling, including pre-marital counselling.

Click Here to Download General Intake Package - New Client Forms

Marriage Check-up Intake Package

Use these forms instead of the General Intake Package if you are coming specifically for a Marriage Checkup (the Informed Consent and Authorization for Services Form includes additional information, and the Intake Questionnaire is a shorter, single-page version instead of the longer two-page version used in the General Intake Package).

Click Here to Download Marriage Checkup Intake Package - New Client Forms

Child and Family Intake Package - New Client Forms

Use these forms instead of the General Intake Package, if the counselling is for a child or youth under the age of 18, or if you are seeking family therapy and plan to have children or youth present in the sessions (there are additional forms to complete for child or family therapy).

Click Here to Download Child & Family Therapy Intake Package - New Client Forms 

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