Client Intake Form Template for United States

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

4.6 / 5

4.8 / 5

Let's create your Client Intake Form

1. Select your governing law and document type:

2. Enter your key requirements:

3. Create your document to edit, review or download

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:

Client Intake Form

"I need a Client Intake Form for my new medical practice in California, compliant with HIPAA and state regulations, that captures both general patient information and detailed medical history for appointments starting January 2025."

Document background

The Client Intake Form is a crucial document used across various professional sectors in the United States to systematically gather client information at the commencement of services. This document typically includes personal identification details, service requirements, relevant history, and specific information pertinent to the service being provided. It must comply with federal regulations such as HIPAA and GLBA, as well as state-specific privacy laws. The form serves multiple purposes: establishing the client relationship, ensuring regulatory compliance, identifying client needs, and creating a foundation for service delivery. It's particularly important for maintaining accurate records and ensuring appropriate service delivery while protecting both the service provider and client.

Suggested Sections

1. Client Information: Basic contact details including name, address, phone, email, and preferred contact method

2. Service Requirements: Nature of services needed or reason for engagement, including specific requirements or preferences

3. Privacy Notice: Statement on how client information will be used and protected, including data handling practices

4. Consent Statement: Client authorization to collect and process information, including specific permissions and acknowledgments

Optional Sections

1. Medical History: Detailed medical background including conditions, medications, and treatment history - for healthcare services

2. Financial Information: Income details, assets, financial obligations, and credit information - for financial or legal services

3. Emergency Contacts: Alternative contact information and relationship details - for healthcare or personal care services

4. Insurance Information: Details of relevant insurance policies and coverage - for healthcare or professional services

5. Professional References: References from other service providers or professionals - for business or professional services

Suggested Schedules

1. Privacy Policy: Detailed privacy policy document explaining how client information is collected, used, stored, and protected

2. Service Terms: Comprehensive terms of service including rights, responsibilities, and limitations

3. Required Disclosures: State or industry-specific required disclosures and compliance statements

4. Fee Schedule: Detailed breakdown of service fees, payment terms, and billing procedures

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
Legal Services
Financial Services
Professional Services
Social Services

Relevant Teams

Client Services
Operations
Compliance
Legal
Administration

Relevant Roles

Office Manager
Compliance Officer
Client Services Manager
Practice Administrator
Intake Coordinator

Find the exact document you need

Electronic Intake Forms

Legal framework for electronic intake forms compliant with US federal and state regulations, governing digital information collection and processing.

How a Sales & Marketing Lead uses Genie AI to reduce contract drafting time by 95%

Let's create your Client Intake Form

Authors

Alex Denne

Find the exact document you need

Electronic Intake Forms

Client Intake Form Law Firm

Law Office Intake Form

Buyer Intake Form

Nonprofit Client Intake Form

Real Estate Intake Form

Online Intake Forms For Massage Therapy

Consignment Intake Form

Creative Project Intake Form

Nonprofit Intake Form

Veterinary Intake Form

Financial Coaching Intake Form

Event Planning Intake Form

Virtual Assistant Intake Form

Massage Client Intake Form

Hypnotherapy Client Intake Form

Home Care Intake Form

Catering Intake Form

Case Intake Form

Referral Intake Form

Inventory Intake Form

Biopsychosocial Intake Form

Wellness Intake Form

Vehicle Intake Form

Real Estate Buyer Intake Form

Marriage Counseling Intake Form

Financial Intake Form

Consulting Intake Form

Case Management Intake Form

Order Intake Form

Bookkeeping Client Intake Form

Salon Client Intake Form

Creative Intake Form

Esthetician Client Intake Form

Client Intake Form

Lead Intake Form

Employment Intake Form

Vendor Intake Form

Intake Assessment Form

Clinical Intake Form

Procurement Intake Form

Patient Intake Form

Download our whitepaper on the future of AI in Legal

Genie’s Security Promise

Your documents are private:

Your documents are protected:

Organizational security

Innovation in privacy:

Want to know more?

Draft quality legal agreements or review documents in 3 minutes

Templates

Commercial

Employment

IP

Administration

Finance

R&D

Industries

Legal Services

Manufacturing

Construction

Solutions

Use Cases

Company Types

Comparisons

Business Categories

Teams

Information