How to create an intake form (client and patient structure + fields)
An intake form gathers the information you need before a first appointment, organized into clear sections: contact and basic details, the reason for the visit, relevant history, and consent. For a client intake (agency, coaching, legal), focus on goals, scope, and how to reach them; for a patient intake, add medical history, current concerns, insurance, and consent. Ask only what you'll use at or before the first session. Below is the structure, the exact fields, a build process, and an example.
An intake form does the groundwork so the first appointment starts productively instead of with a clipboard. The structure is similar across client and patient intake — contact, reason for the visit, relevant history, and consent — but the depth differs. This guide gives the sections, the exact fields for each, a step-by-step build, and a complete example you can adapt. Throughout, the rule holds: collect only what you'll actually use at or before the first session.
What sections does an intake form need?
- Contact and basic details — who they are and how to reach them.
- Reason for the visit — what they need help with.
- Relevant history — background that informs the first session.
- Logistics — scheduling, referral source, insurance (for patients).
- Consent and agreements — privacy, policies, signatures.
Section 1: Contact and basic details
| Field | Field type | Required? |
|---|---|---|
| Full name | Short text | Yes |
| Email address | Yes | |
| Phone number | Phone | Yes |
| Date of birth | Date | Yes for patients; optional for many clients |
| Address | Address | Only if you need it (billing, in-home, mail) |
| Preferred contact method | Multiple choice | No |
Section 2: Reason for the visit
| Field | Field type | Required? |
|---|---|---|
| What brings you in / what do you need help with? | Long text | Yes |
| How urgent is this? | Multiple choice | No |
| What outcome are you hoping for? | Long text | No |
| Have you sought help for this before? | Multiple choice | No |
Section 3: Relevant history
This is where client and patient intake diverge most. Tailor it to what you genuinely need for a productive first session.
For a client intake (agency, coaching, legal, services)
- Company or project background (Long text)
- Scope or budget range (Dropdown or multiple choice)
- Timeline / deadline (Date or multiple choice)
- Relevant documents (File upload)
- Who else is involved in decisions? (Short text)
For a patient intake (health, wellness, therapy)
- Current concerns or symptoms (Long text)
- Relevant medical history (Long text or checkboxes)
- Current medications (Long text)
- Allergies (Long text)
- Emergency contact name and phone (Short text + Phone)
Section 4: Logistics
| Field | Field type | Required? |
|---|---|---|
| Preferred appointment days/times | Checkboxes | No |
| How did you hear about us? | Dropdown | No |
| Insurance provider (patients) | Short text | Only if you bill insurance |
| Insurance member ID (patients) | Short text | Only if you bill insurance |
| Upload insurance card / ID (patients) | File upload | No |
Section 5: Consent and agreements
| Field | Field type | Required? |
|---|---|---|
| Privacy / confidentiality acknowledgment | Consent checkbox | Yes |
| Cancellation / no-show policy agreement | Consent checkbox | Yes |
| Consent to treatment (patients) | Consent checkbox | Yes, where applicable |
| Signature | Signature | Yes for legally binding forms |
Intake forms often collect sensitive information. Keep the form to what you genuinely need, state plainly how the data is used, and treat anything health-related with care. A free form builder can collect intake data, but for regulated health records confirm your tool and process meet your jurisdiction's requirements — Formkii does not offer healthcare compliance certifications.
How do you build an intake form, step by step?
- 1List what you genuinely need before the first session — write it down before opening a builder to keep scope tight.
- 2Create the form and group fields into the sections above, in the order people expect.
- 3Use the right field type for each: an email field validates addresses, a date field for date of birth, file upload for documents or insurance cards, a signature field for waivers.
- 4Add a welcome screen that sets expectations: 'This intake takes about 5 minutes and helps us prepare for your first session.'
- 5Use conditional logic to keep it short — show insurance fields only if they're paying through insurance, for example.
- 6Add the consent section and, if needed, a signature field for a legally binding agreement.
- 7Write a confirmation screen: 'Thanks — we've got your intake. We'll confirm your appointment by email within one business day.'
- 8Test the whole flow on a phone, including file uploads and the signature.
- 9Share via a private link sent directly to the client or patient, and export submissions to CSV for your records.
Example: a coaching client intake form
- 1Welcome: 'Welcome! A few questions before our first call — about 4 minutes.'
- 2Full name, email, phone.
- 3'What would you like to work on?' (long text, required).
- 4'What does success look like for you?' (long text, optional).
- 5'What's your timeline?' (multiple choice).
- 6'Anything we should know before we start?' (long text, optional).
- 7Consent: 'I've read and agree to the coaching agreement and cancellation policy.'
- 8Ending: 'All set! Check your email for a link to book your first session.'
Common intake form mistakes
- Asking for everything 'just in case' instead of what the first session needs.
- Free-text fields where a dropdown or date picker would keep data clean.
- No consent or policy acknowledgment on forms that legally need one.
- Collecting sensitive health or financial data without saying how it's used.
- Showing insurance or specialist fields to everyone instead of using logic.
- No confirmation screen, so clients and patients don't know the form went through.
- Not testing file upload and signature on mobile, where they often break.
Intake form checklist
- Fields are grouped into clear sections in a logical order.
- Every field is something you'll use at or before the first session.
- Field types match the data (date, email, file upload, signature).
- Conditional logic hides fields people don't need (e.g. insurance).
- Consent and any required signature are included.
- A welcome screen sets the time, and a confirmation sets next steps.
- Sensitive data handling is appropriate to the information collected.
- The full flow is tested on a phone.
Frequently asked questions
What is an intake form?
An intake form gathers the information you need before a first appointment or engagement — contact details, the reason for the visit, relevant history, and consent. It lets the first session start productively instead of with paperwork, and it's used widely in healthcare, coaching, legal, and agency settings.
What should a client intake form include?
Contact details, the reason they're reaching out, relevant project or business background, scope and timeline, and consent to your terms. For service businesses, add fields for documents (file upload) and who's involved in decisions. Keep it to what you need to prepare for the first conversation.
What's the difference between a client and a patient intake form?
Both share contact, reason-for-visit, and consent sections, but a patient intake adds medical history, current symptoms or medications, allergies, insurance details, and consent to treatment. A client intake focuses instead on goals, scope, timeline, and supporting documents.
Can I create an intake form for free?
Yes. Free form builders like Formkii support the field types intake forms need — date, file upload, signature, and consent — plus conditional logic and a confirmation screen. For regulated health records, confirm your tool and process meet your jurisdiction's requirements, since most free form tools don't offer healthcare compliance certifications.