A Starter Intake Form

Intake forms are important.

They're one of the first places a client interacts with your practice.

You want to make a good first impression.

You want to capture as much information as you can, but you don't want your client to feel overwhelmed.

You want your form to reflect a caring and thoughtful clinical approach. 

You'd rather that it be convenient for the client to complete.

Ideally, the client will feel that completing the form is part of the healing interaction rather than a confusing waste of time.

There isn't a perfect one.

I revise mine ... oh, at least once every week or two.

Some questions are worded weirdly, so I'll fix them.

Sometimes I have a new client and realize the form didn't capture something it could have.

Sometimes I realize that I can remove questions because I'm not really using the responses or because I always ask those questions during the first visit.

It's hard to start from scratch.

After working with tons of folks who are just starting out, I know that having an intake form to start with can be a big stumbling block.

You may have one from your training, but you may not love it.

It may not be in a format where you can easily modify it to suit your practice.

Or, you might have been in practice for years, using a form you like but don't love. 

The idea of starting from a blank page is overwhelming.

I decided to make my intake form available for you.

Caveat: it's not perfect.

I'm sure it will change repeatedly.

It may not be a good fit for everyone.

But I want you to have somewhere to start. This form works really well for me, with a practice focused on repro-health and with about an hour for a new client visit.

A few requests:

  • If you see anything that looks wrong or could be improved, could you let me know? Comment below or message me.
  • If you have any questions that work well for you that I should consider adding, will you let me know? Comment below or message me.
  • If you'd like to share this with someone else, could you send them to this post rather than sharing the form directly?

How to Access My Intake Form

Extras for Practice Better Users

Please note that this form is usually administered online via Practice Better. I don't send clients the PDF to complete. One of the cool things about Practice Better is that these kinds of forms are easily fillable on any kind of device. It's super simple to update the forms as needed.

Which I do. Often.

Some questions are only revealed if the client checks a previous box (e.g. all of the pregnancy/menstrual cycle questions are hidden if someone check that these are not relevant for them.)

You can read my full review of Practice Better here if you're interested.

If you use Practice Better as a practitioner, you can use the following code to import my intake form directly into your own account to use or modify:

Access code: form_5c7d70c0627d7910483b7261d57776808253b9ea
Instructions to Import this Form into your account

Please let me know if you have questions or suggestions!

I hope it's helpful! 

xo,

Camille

Weekly Practitioner Notes

If you found the intake form helpful, you might enjoy receiving my weekly(ish) practitioner notes ❤️


Thoughts? Add your comments here. 

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Camille Freeman (she/her)

Hi there! I'm a clinical herbalist and licensed nutritionist specializing in fertility and reproductive health. I faciliate the Monday Mentoring community of practice and offer continuing eduation programs for highly trained herbalists & nutritionists. I'm also a professor in the Department of Nutrition at the Maryland University of Integrative Health, where I teach physiology, pathophysiology, and mindful eating. 

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