Clinical Intake Form Template for England and Wales

Create a bespoke document in minutes,  or upload and review your own.

4.6 / 5
4.8 / 5

Let's create your Clinical Intake Form

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

Clinical Intake Form

I need a Clinical Intake Form for my new private psychology practice opening in March 2025, focusing on adult mental health services and including specific sections for anxiety and depression screening.

Document background
The Clinical Intake Form serves as the primary document for gathering patient information when they first engage with a healthcare service in England and Wales. This document is essential for establishing a medical record that complies with UK healthcare regulations and data protection laws. It typically includes sections for personal information, medical history, current medications, allergies, and informed consent. The form ensures healthcare providers collect consistent, comprehensive information while meeting their legal and professional obligations under UK law.
Suggested Sections

1. Patient Demographics: Basic personal information including name, date of birth, NHS number, gender, address, contact details, preferred contact method

2. Emergency Contacts: Details of next of kin and emergency contacts including relationship, contact information and access permissions

3. Medical History: Current and past medical conditions, surgeries, medications, allergies, immunizations and family medical history

4. Consent Declaration: Patient's explicit consent for treatment, data processing, and information sharing in accordance with UK GDPR

5. Insurance Information: Details of medical insurance if applicable, including policy numbers and coverage details

Optional Sections

1. Mental Health Assessment: Detailed mental health history, current symptoms, and previous treatments - required for psychiatric or psychological services

2. Pain Assessment: Comprehensive pain evaluation including location, intensity, duration and triggers - used for pain management or chronic conditions

3. Substance Use History: Detailed history of alcohol, tobacco, or drug use, including current usage and treatment history - relevant for addiction or recovery programs

4. Disability Assessment: Evaluation of any disabilities and required accommodations - used when specific accessibility needs must be addressed

5. Cultural and Religious Considerations: Specific cultural or religious requirements that may affect treatment or care delivery

Suggested Schedules

1. Privacy Notice: Detailed information about how patient data will be used, protected, and shared in compliance with UK GDPR and Data Protection Act 2018

2. Patient Rights and Responsibilities: Comprehensive document outlining patient's rights, responsibilities, and complaint procedures

3. Medical Records Release Authorization: Standard form for authorizing release of medical information to specified third parties

4. Capacity Assessment Form: Template for recording mental capacity assessments when required under Mental Capacity Act 2005

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

Relevant legal definitions
Clauses
Relevant Industries
Relevant Teams
Relevant Roles
Industries

UK GDPR and Data Protection Act 2018: Primary legislation governing how personal and medical data must be collected, processed, and stored in the UK following Brexit. Key for ensuring compliant handling of patient information in clinical intake forms.

Health and Social Care Act 2008: Fundamental legislation establishing the regulatory framework for health and social care services in England and Wales, including requirements for clinical documentation and record-keeping.

Care Quality Commission Regulations 2009: Specific regulations detailing requirements for healthcare providers' registration and ongoing compliance, including standards for documentation and patient information collection.

Access to Health Records Act 1990: Legislation governing patients' rights to access their health records and the requirements for maintaining medical records, directly impacting how clinical information must be documented.

Medical Act 1983: Core legislation establishing the framework for medical practice regulation in the UK, including requirements for medical record-keeping and professional standards.

Mental Capacity Act 2005: Essential legislation for determining and documenting patient capacity to consent, crucial for clinical intake processes where capacity assessment may be necessary.

Equality Act 2010: Legislation ensuring non-discriminatory practices in healthcare provision and documentation, requiring inclusive and accessible clinical intake procedures.

Professional Standards Requirements: Guidelines from regulatory bodies like GMC and NMC that set specific standards for clinical documentation and patient information collection.

Common Law Duty of Confidentiality: Legal obligation to maintain patient confidentiality, fundamental to the design and implementation of clinical intake forms and information handling procedures.

NHS Constitution: Framework establishing patient rights and NHS responsibilities, influencing how clinical information should be collected and managed while respecting patient rights.

Human Rights Act 1998: Overarching legislation ensuring respect for human rights in healthcare contexts, including privacy and dignity in clinical documentation processes.

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

Find the exact document you need

Therapy Intake Form

find out more

Spray Tan Intake Form

find out more

Real Estate Lead Intake Form

find out more

Real Estate Client Intake Form

find out more

Program Intake Form

find out more

Potential Client Intake Form

find out more

Phone Intake Form

find out more

New Client Intake Form Law Firm

find out more

New Client Intake Form

find out more

Marketing Client Intake Form

find out more

Intake Referral Form

find out more

Initial Intake Form

find out more

Client Intake Assessment Form

find out more

Client Assessment Form Counselling

find out more

Cavitation Intake Form

find out more

Business Client Intake Form

find out more

Aromatherapy Client Intake Form

find out more

Nonprofit Client Intake Form

A standardized form used by nonprofits in England and Wales to collect client information and service requirements while maintaining compliance with UK data protection laws.

find out more

Consignment Intake Form

A legal document used in England and Wales to record receipt of goods for consignment sale, serving as both receipt and contract.

find out more

Nonprofit Intake Form

A standardized form used by UK nonprofits to collect and process initial service user information, compliant with England and Wales charity law.

find out more

Financial Coaching Intake Form

A regulatory-compliant intake form for financial coaching services in England and Wales.

find out more

Event Planning Intake Form

A standardized form used in England and Wales to collect crucial event planning information from clients, ensuring compliance with UK regulations.

find out more

Catering Intake Form

A standardized form for collecting catering service requirements under English and Welsh law.

find out more

Case Intake Form

A standardized form used in England and Wales legal practice for collecting new client and case information, ensuring regulatory compliance.

find out more

Referral Intake Form

A standardized document used in England and Wales for recording and processing service referrals while ensuring compliance with UK regulations.

find out more

Inventory Intake Form

A legal document used in England and Wales to record property condition and contents for tenancy management purposes.

find out more

Wellness Intake Form

A legal document used in England and Wales for collecting client health and personal information before providing wellness services.

find out more

Vehicle Intake Form

A legal document used in England and Wales to record vehicle condition and details upon entry to a service facility.

find out more

Marriage Counseling Intake Form

A regulated intake document used in England and Wales for collecting essential information from couples seeking marriage counseling services.

find out more

Financial Intake Form

A regulatory-compliant document used in England and Wales to gather client financial information and establish financial service relationships.

find out more

Consulting Intake Form

A standardized form used in England and Wales to collect initial client information and project requirements for consulting engagements.

find out more

Case Management Intake Form

A standardized form used in England and Wales legal practice for collecting new client information and initializing case management processes.

find out more

Order Intake Form

A standardized form under English and Welsh law for capturing and processing customer orders, ensuring legal compliance and clear documentation of transaction details.

find out more

Bookkeeping Client Intake Form

A standardized form used in England and Wales to collect new client information for bookkeeping services, ensuring compliance with UK regulations.

find out more

Salon Client Intake Form

A legally compliant form used in England and Wales for collecting essential client information and consents for salon services.

find out more

Creative Intake Form

A standardized form used in England and Wales for gathering client requirements and project specifications for creative services.

find out more

Lead Intake Form

A legally compliant form for collecting potential customer information under English and Welsh law.

find out more

Employment Intake Form

A standardized document used in England and Wales for collecting essential information from new employees during onboarding, ensuring legal compliance.

find out more

Vendor Intake Form

A standardized form under English and Welsh law for collecting essential vendor information during the supplier onboarding process.

find out more

Clinical Intake Form

A standardized medical documentation tool used in England and Wales for collecting essential patient information and consent at initial healthcare contact.

find out more

Procurement Intake Form

A standardized form used in England and Wales to initiate and document procurement requests, ensuring regulatory compliance and procurement best practices.

find out more

Download our whitepaper on the future of AI in Legal

By providing your email address you are consenting to our Privacy Notice.
Thank you for downloading our whitepaper. This should arrive in your inbox shortly. In the meantime, why not jump straight to a section that interests you here: https://www.genieai.co/our-research
Oops! Something went wrong while submitting the form.

Genie’s Security Promise

Genie is the safest place to draft. Here’s how we prioritise your privacy and security.

Your documents are private:

We do not train on your data; Genie’s AI improves independently

All data stored on Genie is private to your organisation

Your documents are protected:

Your documents are protected by ultra-secure 256-bit encryption

Our bank-grade security infrastructure undergoes regular external audits

We are ISO27001 certified, so your data is secure

Organizational security

You retain IP ownership of your documents

You have full control over your data and who gets to see it

Innovation in privacy:

Genie partnered with the Computational Privacy Department at Imperial College London

Together, we ran a £1 million research project on privacy and anonymity in legal contracts

Want to know more?

Visit our Trust Centre for more details and real-time security updates.