Get the free Couple Intake Form

This document is an intake form for couples seeking counseling services. It collects personal information, insurance details, emergency contacts, and consent for treatment and billing procedures.

How to fill out couple intake form

How to fill out Couple Intake Form

1. Start by entering the full names of both partners at the top of the form.
2. Provide contact information, including phone numbers and email addresses for both individuals.
3. Fill in the date of birth for each partner.
4. Indicate the length of the relationship and any important dates (e.g., engagement, marriage).
5. List any previous relationships and relevant information that may be necessary.
6. Describe the current relationship dynamics, including any issues or concerns.
7. Include any relevant medical or psychological history for both partners.
8. Provide information about goals for therapy or counseling, if applicable.
9. Review all entries for accuracy before submission.
10. Submit the completed form as instructed, either online or in person.

Who needs Couple Intake Form?

1. Couples seeking relationship counseling or therapy.
2. Partners looking to understand their relationship dynamics better.
3. Couples preparing for marriage or entering a long-term commitment requiring professional guidance.
4. Any partners wanting to address specific issues or improve communication within the relationship.

For pdfFiller’s FAQs

What is Couple Intake Form?

A Couple Intake Form is a document used by therapists or counselors to gather information about a couple's relationship history, issues, and goals for therapy.

Who is required to file Couple Intake Form?

Couples seeking therapy or counseling services are required to fill out a Couple Intake Form to provide their therapists with relevant background information.

How to fill out Couple Intake Form?

To fill out a Couple Intake Form, both partners should provide their personal information, relationship history, details about their concerns, and any relevant medical or psychological history as required by the form.

What is the purpose of Couple Intake Form?

The purpose of the Couple Intake Form is to help therapists understand the dynamics of the relationship, identify issues, and develop appropriate treatment plans.

What information must be reported on Couple Intake Form?

The Couple Intake Form typically requires information such as names, contact details, relationship duration, reasons for seeking therapy, individual backgrounds, and any previous counseling experiences.