Counseling Intake Interview Form Template for Australia

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Key Requirements PROMPT example:

Counseling Intake Interview Form

"I need a Counseling Intake Interview Form for my new private practice opening in March 2025, specifically designed for youth counseling services (ages 12-25) with additional sections for parental consent and social media communication preferences."

Document background

The Counseling Intake Interview Form is a critical document used in Australian counseling practices to initiate the therapeutic relationship with new clients. It serves as the primary tool for collecting comprehensive client information, including personal details, medical history, mental health background, and emergency contacts, while ensuring compliance with Australian privacy laws and healthcare regulations. This document is essential for risk assessment, treatment planning, and maintaining proper clinical records. The form includes mandatory privacy notices and consent sections as required by the Privacy Act 1988 and relevant state-based health records legislation. It is designed to be used at the first point of contact with new clients and provides the foundation for developing appropriate treatment strategies while protecting both the client's and practitioner's interests.

Suggested Sections

1. Client Personal Information: Basic demographic information including name, date of birth, contact details, preferred contact method, and identification details

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

3. Current Situation: Presenting issues, reasons for seeking counseling, and current concerns

4. Privacy Notice and Consent: Information about how personal data is collected, used, and protected, aligned with Privacy Act 1988 requirements

5. Medical Information: Current medications, relevant medical conditions, and treating healthcare providers

6. Mental Health History: Previous counseling/therapy experiences, diagnoses, and treatments

7. Risk Assessment: Standard questions regarding self-harm, suicide risk, and harm to others

8. Client Agreement: Client acknowledgment and consent to counseling services, terms, and conditions

Optional Sections

1. Insurance Information: Used when the client is claiming through insurance or Medicare

2. Cultural Background: Include when the practice specifically caters to diverse cultural groups or when cultural considerations are particularly relevant

3. Substance Use History: Include when the practice deals with addiction counseling or when substance use screening is relevant

4. Legal Status: Include when working with clients involved in legal proceedings or when counseling is court-mandated

5. Family History: Include when family therapy is offered or when intergenerational issues are relevant

6. Remote Counseling Consent: Include when telehealth or online counseling services are offered

Suggested Schedules

1. Schedule A - Fee Schedule: Detailed breakdown of service fees, cancellation policies, and payment terms

2. Schedule B - Privacy Policy: Detailed privacy policy and information handling procedures

3. Schedule C - Client Rights and Responsibilities: Comprehensive outline of client rights, responsibilities, and complaint procedures

4. Appendix 1 - Crisis Support Resources: List of emergency contacts, crisis helplines, and community resources

5. Appendix 2 - Standardized Assessment Tools: Any initial assessment scales or questionnaires used in the intake process

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 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

Mental Health Services

Healthcare

Social Services

Education and Training

Employee Assistance Programs

Community Services

Private Practice

Public Health

Youth Services

Aged Care Services

Relevant Teams

Clinical Operations

Mental Health Services

Client Services

Administration

Compliance and Risk Management

Quality Assurance

Front Desk Operations

Records Management

Professional Standards

Client Care

Relevant Roles

Counselor

Psychologist

Mental Health Practitioner

Clinical Director

Practice Manager

Healthcare Administrator

Intake Coordinator

Clinical Supervisor

Mental Health Nurse

Social Worker

Client Services Manager

Quality Assurance Officer

Compliance Manager

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Authors

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