This client intake form is designed for adoption and foster care therapy settings where background, caregiving structure, and relationship context matter from the start. It gives families and caregivers a clear way to share the child’s basic information, caregiver contacts, and role in the child’s life before the first session.
The template includes practical intake questions such as caregiver name, relationship to child, email address, phone number, secondary caregiver details, the child’s name, preferred name, pronouns, and date of birth. That structure helps therapists, counselors, psychologists, and social workers begin with accurate household information while creating space for more detailed history, attachment concerns, trauma background, and family integration notes.
Because this is a sensitive patient intake form, the flow is organized to feel straightforward rather than overwhelming. It supports early clinical preparation, reduces back-and-forth for missing details, and helps providers understand who is involved in the child’s care before treatment planning begins.
