Once you’ve found a therapist you would like to work with, the intake process is the next step. Every practitioner has their own process, but one thing we all have in common is that there is going to be some paperwork. There are a multitude of laws and regulations that govern this. When I set up a new client, I usually apologize for all the forms I’m about to send them. Not all therapists will send the same forms- I think I fall on the paperwork-heavier end of the spectrum- but you can count on needing to read and sign at least a couple of forms. In this post I’ll try to explain some of what you might expect in your intake with a new therapist.
Getting To Know You
Therapists all have their own way of getting background information (sometimes called a social history). This could include basic demographics, some details about your medical history and any medication you take, brief information about the current concerns that bring you to therapy, your family history, and any prior mental health treatment you may have had. Some therapists like to have clients fill out an intake form with all or some of that information before the first meeting. Some like to have very basic information completed first (basic contact and demographic information, for example), and will use session time to gather more thorough background information. Therapist style plays a role here, too- there may be a structured form or interview with specific questions to go through, while in other cases there may be a more narrative-style approach as you are asked to share your story.
These questions about you may, at times, feel intrusive but are important for a few reasons. First, the most practical reason is because your therapist needs to know some basic information: your age, what name you prefer, your contact information, your living situation, etcetera. If you’re using telehealth, it’s a good idea for your therapist to ask you for emergency contact information as well- where you’re located at the time of sessions and who they can contact in the event of a crisis.
A more detailed background can give the therapist some idea of what you’re looking to work on, which helps to frame your goals in therapy (more on goals in a future post). It also helps the therapist to understand any risks they may need to monitor or address- concerns about safety, or health worries for example. And the therapist may also use questionnaires or "screening tools" to gather information about your concerns or symptoms to form a preliminary diagnosis, especially if they accept insurance (insurance companies require a diagnosis). It’s important that you be as open and as honest as you can be and talk with the therapist about any concerns you may have about answering any of the questions.
What You’re Signing Up For
It’s best practice- and often required- for a therapist to give new clients information about what they’re entering into when they start therapy. Often called Informed Consent forms, these can range from a very simple summary or a more detailed explanation of the benefits and risks of therapy. This form may include information about confidentiality or privacy policies (all that HIPAA stuff), or those may be provided on a separate form. For some types of therapy- if you’re engaged in couple’s counseling, or if you’re the parent of a minor who is receiving the care for example- you may also be given informed consent forms specific to that work. And, if you’re engaged in telehealth services, this will probably include some form of consent for telehealth, specifically outlining the risks and benefits of that format. Your therapist will ask you to sign off stating that you’ve received and understand this information. Again, it’s important to ask questions if there’s anything you don’t understand.
Practice Policies
Every therapist will have their own way of providing you with information about how you’ll work together. This could include information ranging from how to contact your therapist, scheduling appointments, cancelation policies, payment policies (more on that later), and what to do in the case of an emergency. My practice policies also include information about my policies regarding social media, electronic communication, working with minors, involvement in court cases, and ending therapy. As I experience new things with clients, my policies evolve, so I make it a practice to send existing clients any updates to my policies- in yet another form. I know that it’s a lot to read and it may be tempting to skim and sign, but I do encourage people to read them carefully to avoid misunderstandings or surprises down the road.
Payment Information
Your therapist may include payment information in their general practice policies or may break that out as a separate form. Whether your therapist accepts insurance, is self-pay only, is seeing you through an Employee Assistance Program, or some other arrangement, it is important for you to be clear about their payment policies. This can include how payments are made and when they’re expected, session fees, cancelation fees, fees for anything outside of session time (do they charge a fee for attending a school IEP meeting, or for completing paperwork for a disability claim, for example?), and anything related to insurance you may be using.
If your therapist takes insurance, you can expect them to ask you for a picture of the front and back of your insurance card, along with information that allows them to confirm benefits and submit bills. Some therapists may require a credit card on file for billing co-pays and other charges. You may also get forms to sign giving them permission to get paid directly by the insurance company and/or to charge your credit card when needed.
If you are paying out of pocket rather than using insurance, your therapist is probably going to give you a Good Faith Estimate (GFE) which, as of the time of this writing, is a relatively new law. The intent is to prevent surprise billing but remember that it's only an estimate. You can talk more with your therapist about any factors that might impact your costs.
Your intake paperwork may include a form to review and possibly sign saying that you are aware of all these policies and accept responsibility for any charges. Be sure to review these carefully and talk about any that you have questions about.
Release of Information Forms
If you need your therapist to be in contact with other people- a prescriber, a school counselor, a family member, an attorney- they'll likely ask you to sign a release, also called an ROI form. There are situations when your therapist is not required to get your signed consent for contact, which vary from state to state, so it’s good to know what those situations may be. The privacy policies from your therapist should outline that information.
A Final Word
Paperwork requirements are always evolving, and so you might find that your therapist sends out new forms, or updated policies, or more requests for information from you. No one comes to therapy to fill out forms, and no one becomes a therapist for the love of the paperwork (I mean, maybe SOMEONE does, but I don’t know them) but, while these forms are sometimes a hassle, they are often a necessary part of engaging in therapy. I encourage you to take the time to understand them before you sign.