Counseling Intake Form Template for India

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Key Requirements PROMPT example:

Counseling Intake Form

"I need a Counseling Intake Form for my new private practice in Mumbai opening in January 2025, focusing on adolescent mental health services with both in-person and online counseling options, including parent/guardian consent sections and social media communication policies."

Document background

The Counseling Intake Form is a fundamental document used at the commencement of counseling services in India, designed to gather comprehensive client information and establish the therapeutic relationship. This document must comply with the Mental Healthcare Act, 2017, and other relevant Indian healthcare regulations. It is typically used during the first interaction between a mental health professional and a client, collecting vital information about the client's mental health history, current concerns, and treatment goals. The form includes necessary consents, confidentiality agreements, and financial arrangements, serving as both a clinical assessment tool and a legal document. It helps mental health professionals maintain proper documentation while ensuring client rights are protected and services are delivered in accordance with Indian legal requirements.

Suggested Sections

1. Client Information: Basic personal details including name, age, contact information, and emergency contact

2. Presenting Concerns: Primary reasons for seeking counseling and current symptoms or challenges

3. Medical History: Relevant medical conditions, medications, and previous mental health treatment

4. Risk Assessment: Basic screening for immediate safety concerns including suicide risk and self-harm

5. Consent for Treatment: Client's agreement to receive counseling services and acknowledgment of their rights and responsibilities

6. Confidentiality Statement: Explanation of privacy policies and limits to confidentiality

7. Financial Agreement: Fee structure, payment policies, and cancellation procedures

8. Communication Preferences: Preferred methods of contact and authorization for appointment reminders

Optional Sections

1. Family History: Detailed family mental health history, recommended for genetic risk assessment

2. Substance Use Assessment: Detailed questions about current and past substance use, necessary for addiction counseling

3. Trauma History: Specific section for trauma-related information, used when trauma counseling is anticipated

4. Cultural Background: Information about cultural factors that may influence treatment, important for culturally sensitive care

5. Academic/Career Information: Relevant for career counseling or student clients

6. Relationship Status: Detailed relationship history for relationship counseling

7. Telehealth Consent: Additional consent for virtual counseling services when offered

Suggested Schedules

1. Privacy Policy: Detailed explanation of data protection measures and client privacy rights

2. Fee Schedule: Comprehensive list of service fees and payment terms

3. Client Rights and Responsibilities: Detailed document outlining client's rights and obligations during treatment

4. Emergency Procedures: Protocol for emergency situations and crisis contacts

5. Complaint Procedure: Process for filing and handling client grievances

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

Healthcare

Mental Health Services

Education

Corporate Wellness

Social Services

Employee Assistance Programs

Rehabilitation Services

Addiction Treatment

Youth Services

Family Services

Relevant Teams

Mental Health Services

Clinical Operations

Healthcare Administration

Legal & Compliance

Patient Services

Wellness & Support

Quality Assurance

Records Management

Client Relations

Professional Standards

Relevant Roles

Mental Health Counselor

Clinical Psychologist

Psychiatrist

Social Worker

School Counselor

Marriage and Family Therapist

Addiction Counselor

Corporate Wellness Counselor

Healthcare Administrator

Clinical Director

Legal Compliance Officer

Mental Health Program Manager

Student Counselor

Employee Assistance Program Coordinator

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Authors

Alex Denne

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