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Therapy first session intake - Illustrated landing

A gentle intake for a first counselling session: what brings you, goals, support, safety check and practical preferences. A brand-colour landing page with a hero, illustrated background and a card for each section.

About 6 min to complete. mental health, therapy, counselling, intake, illustrated.

Use this template

Questions in this template

  1. Name you would like us to use
  2. Email
  3. Phone
  4. What is bringing you to therapy?
  5. In your own words, what would you like help with?
  6. How have you been feeling this past week?
  7. Have you seen a therapist before?
  8. What helped, and what did not?
  9. In the past two weeks, have you had thoughts of harming yourself?
  10. If you are in danger right now, call your local emergency number. In the United States you can call or text 988 at any time.
  11. How would you prefer to meet?

Related templates

Yellow armchair beside a brass floor lamp

Welcome. Take your time.

Nothing here is a test. Share what feels useful and your therapist will take it from there.
Takes about 3 minutes
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