Therapy Intake Form Template for England and Wales

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Key Requirements PROMPT example:

Therapy Intake Form

"I need a Therapy Intake Form for my private psychology practice in London that specializes in cognitive behavioral therapy, compliant with GDPR and including specific sections for trauma assessment and online therapy consent."

Document background
The Therapy Intake Form is a crucial document required at the initiation of any therapeutic relationship in England and Wales. It serves multiple purposes: gathering essential client information, establishing the therapeutic contract, ensuring informed consent, and maintaining compliance with UK GDPR and healthcare regulations. This document is typically completed before or during the first therapy session and forms part of the client's clinical record. It should be regularly reviewed and updated to ensure ongoing compliance with evolving healthcare standards and data protection requirements.
Suggested Sections

1. Personal Information: Basic client details including name, contact information, and emergency contacts

2. Medical History: Current and past medical conditions, medications, and treatments

3. Mental Health History: Previous mental health treatments and diagnoses

4. Consent for Treatment: Client's agreement to receive therapy services

5. Confidentiality Statement: Information about privacy policies and limits of confidentiality

6. Payment and Cancellation Policies: Financial arrangements and appointment policies

Optional Sections

1. Risk Assessment: Additional assessment section for clients presenting with potential risk factors - used when working with high-risk clients or required by insurance

2. Parent/Guardian Consent: Additional authorization section for treating minors or those lacking capacity - used when client is under 18 or lacks mental capacity

3. Insurance Information: Section for health insurance coverage details - used when accepting insurance payments

Suggested Schedules

1. Privacy Notice: Detailed GDPR-compliant privacy information

2. Client Rights and Responsibilities: Detailed explanation of therapy relationship expectations

3. Crisis Support Information: Emergency contact numbers and resources

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

Clauses
Industries

UK GDPR and Data Protection Act 2018: Primary legislation governing the collection, processing, and storage of personal and sensitive health data. Essential for therapy intake forms as they collect sensitive personal information.

Mental Health Act 1983 (amended 2007): Provides the legal framework for mental health treatment and patient rights in England and Wales. Relevant for understanding the legal context of therapeutic services.

Health and Social Care Act 2012: Legislation covering general healthcare provision and standards in England and Wales. Sets out requirements for healthcare service delivery.

Mental Capacity Act 2005: Legislation governing consent and capacity issues. Critical for ensuring clients have the capacity to consent to therapy and understand the treatment process.

Professional Standards Guidelines: Including BACP Ethical Framework, UKCP Code of Ethics, and HCPC Standards. These provide professional guidelines for therapeutic practice and documentation.

Equality Act 2010: Ensures non-discriminatory practices and reasonable accommodations in service provision. Must be considered in form design and service accessibility.

Consumer Rights Act 2015: Relevant for private practice therapy services, establishing consumer rights and service provider obligations in therapeutic relationships.

Common Law Duty of Confidentiality: Legal principle protecting client information and privacy. Essential for establishing confidentiality terms in therapy documentation.

Children Act 1989: Crucial when working with minors, covering safeguarding responsibilities and parental consent requirements in therapeutic contexts.

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

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