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> Client Intake Checklist
Client Intake Checklist
Basic Information
Collect client’s full name
Gather contact information (phone number, email address)
Obtain mailing address
Request preferred method of communication
Background Information
Ask about the client’s occupation and employer
Inquire about the client’s date of birth
Collect emergency contact details
Document any relevant personal background information
Service Needs
Clarify the client’s reason for seeking services
Identify specific goals or outcomes the client hopes to achieve
Discuss any previous services or support received
Determine the timeline for services
Financial Information
Discuss payment methods and options
Collect insurance information, if applicable
Inquire about income level or financial situation
Explain any fees or costs associated with services
Consent and Agreements
Review and obtain consent for services
Explain confidentiality and its limits
Discuss any agreements or contracts to be signed
Provide information about client rights and responsibilities
Additional Notes
Document any special requests or needs from the client
Note any referrals or recommendations made
Record any follow-up actions required
Ensure all information is accurate and complete
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