Who Wrote Your Intake Forms?

I recently switched EHR platforms and rebuilt every form from scratch. I realized how important these are, and how necessary it is to review and revise them periodically. I think it’s helpful to take a fresh look and a critical eye, and ask ourselves whether we are following convention blindly or if we are actually saying precisely what is necessary and important.

Building Private Practice Intake Forms

A note on context: I run a private pay practice. I am pursuing Medi-Cal credentialing, and when I do I will need to create a separate set of forms specific to those clients, because accepting Medi-Cal changes the frame in a number of ways. What I describe here applies to private pay work.

These documents are not administrative. They are the first expression of our clinical frame, and the frame shapes the therapeutic relationship before the first session begins. In private pay private practice, that frame is almost entirely ours. There are legal and ethical structures we practice within, and it is our job to understand them, communicate them clearly, and behave accordingly. But nobody else is constructing the holding environment. The freedom that comes with private practice is also a responsibility that warrants deep attention.

Informed Consent for Therapists: Beyond the Boilerplate

When clients push against the frame, our ability to hold it and work with what is happening in part depends on whether we can stand behind our policies and boundaries with genuine conviction. In moments of frame enactment, the difference between a frame that is genuinely ours and one that is borrowed shows up directly in our clinical capacity. Uncertainty about our own position makes it harder to recognize and use the transference. It makes collapse or over-explanation more likely than curiosity. A frame we can stand behind with integrity is not just ethically cleaner, it is more clinically useful.

Most of us set up our documentation once, under time pressure, borrowing from templates, agency norms, and what other therapists were doing. Some of what ends up in our documentation is genuinely required but some of what we think is required, is not.

Examining Unconscious Norms

Here is an adjacent example: Consider the outgoing voicemail that ends with: “If this is an emergency, please hang up and call 911.” Without enough of us asking what is actually being communicated here, and why, this has spread through the profession as a norm. Consider a client who has never once overstepped, who is calling because they are frightened and you are the person they trust. Is there a reason to tell this person to hang up? Does anyone need to be told to hang up? Does your client need to be reminded that 911 exists? If you have a different crisis line, have you called it to see what your client might experience? If a client is on their way to the ER, do you not want them to leave a message to let you know? These questions are worth asking. The instruction that sounds protective may just be fear that hasn't been examined.

There are real clinical reasons to think carefully about how available we make ourselves to highly distressed clients, and those are worth working out thoughtfully, both in our own minds and directly in the clinical relationship where it actually belongs. But a blanket instruction on a voicemail greeting is a blunt instrument that lands on everyone equally, and feels dismissive and cold to people who call us for the first time. It is not required. It is not in the BBS ethics code. It is not a HIPAA mandate. But for some reason, this persists as a profession-wide default.

These same unexamined norms can be found throughout our documentation. We carry norms from agency and institutional work into private practice without asking whether they translate. We use language that sounds official without knowing where it came from or whether it applies.

Reclaiming the Intake Process

I do give clients a boilerplate HIPAA notice because that one has genuine legal requirements, but I also know it is the form almost no one reads because it is too long and dense. Maybe that form is the exception, or maybe it just needs more work and it’s the next thing to tackle.

When I went back through my own forms, I could see how hard I had worked on them years ago. I could also see how much language that felt dead and mechanical had somehow made it into the documents despite that effort. I feel particularly good about my new telehealth consent that names the actual embodied cost of working through a screen rather than just listing legal disclaimers about a software platform. I like that my couples informed consent better fleshes out my approach to confidentiality regarding individual disclosures, and explains up front some of the issues regarding seeking insurance reimbursement for couples work.

Generally, I also just enjoyed cutting whatever I didn’t need. I realized I had crisis numbers in my informed consent, as if anyone was going to log into my portal to look at them when they were in distress! I made it as concise as I could, and tried to make sure the document was written in my voice. None of these are complicated changes, but I want my intake process to be part of the holding environment I provide.

I also now start my “Informed Consent and Practice Policies” with the following paragraph in bold:

"We are all inundated with terms of service and consent forms, and it can be tempting to scroll to the signature. I am asking you to resist that temptation here. I have worked hard to describe clearly how I work and what I ask of my clients, and these policies matter to our work together. I will assume you have read and understood everything here. Note any questions and bring them to our first session."

These forms can reflect what you actually believe, and how you actually work. The language in them is shaping the relationship, and revisiting them is not housekeeping, it’s clinical work. I found that I enjoyed it more than I expected to.

If you would like copies of the forms I use, I am happy to share them with you. I’d love your critical feedback.