Client Intake Form Template

This Client Intake Form (the “Form”) is used by [Business/Firm Name] to collect information for onboarding and service planning.

1. Client Information

1.1 Client Type. ☐ Individual ☐ Company/Organization ☐ Other: [Type].
1.2 Client Name (Legal Name). [Full name or company legal name].
1.3 Preferred Name (Optional). [Preferred name].
1.4 Primary Contact (If Company). [Name and title].
1.5 Phone Number. [Phone].
1.6 Email Address. [Email].
1.7 Mailing Address. [Address].
1.8 Website (Optional). [URL].
1.9 Time Zone (Optional). [Time zone].

2. Preferred Communication

2.1 Preferred Contact Method. ☐ Email ☐ Phone ☐ Text ☐ Video call ☐ Other: [Method].
2.2 Best Times to Contact. [Days/times].
2.3 Communication Notes (Optional). [Language preferences, accessibility needs, etc.].

3. Service Request

3.1 Type of Service Needed. [Describe].
3.2 Reason for Request / Background. [Short explanation].
3.3 Goals and Desired Outcome. [What success looks like].
3.4 Key Deliverables (If Known). [Documents, work product, scope].
3.5 Urgency Level. ☐ Low ☐ Medium ☐ High ☐ Urgent.
3.6 Important Dates/Deadlines. [Dates].

4. Project or Matter Details

4.1 Brief Timeline. [When the work should start/end].
4.2 Budget Range (Optional). ☐ Under $[] ☐ $[]–$[] ☐ $[]+ ☐ Prefer not to say.
4.3 Decision Maker (If Different). [Name/title].
4.4 Other Stakeholders (Optional). [Names and roles].
4.5 Risks/Constraints (Optional). [Known issues, restrictions, compliance concerns].

5. Documents and Information Provided

5.1 Documents Attached/Provided.
☐ ID verification (if needed)
☐ Prior agreements/contracts
☐ Invoices/receipts
☐ Emails/communications
☐ Policies/terms
☐ Other: [List]
5.2 How Documents Were Provided. ☐ Email ☐ Portal ☐ In person ☐ Other: [Method].
5.3 Missing Documents (Optional). [List what is still needed].

6. Conflicts and Related Parties (Optional)

6.1 Opposing Parties / Related Entities (If Any). [Names].
6.2 Related Matters (Optional). [Describe].
6.3 Potential Conflicts Notes. [Anything the provider should know].

7. Privacy and Consent

7.1 Use of Information. The information in this Form will be used to evaluate and provide services and to communicate with the Client.
7.2 Consent. The Client consents to the collection, storage, and use of the information provided in this Form for the purposes stated above.
7.3 Marketing Consent (Optional).
☐ Client agrees to receive updates and marketing emails
☐ Client does not agree to receive marketing emails
7.4 Data Retention (Optional). Intake records will be retained for: [__] years, unless required otherwise by law or policy.

8. Acknowledgments (Optional)

8.1 No Legal Advice / No Relationship (Optional). Submitting this Form does not, by itself, create a client relationship or guarantee services unless confirmed in writing by [Business/Firm Name].
8.2 Accuracy. Client confirms the information provided is accurate to the best of their knowledge.

Signatures

By signing below, the undersigned acknowledge that the information provided is accurate and agree to the consent terms in this Form.

Client Name: [Name]
Date: [Date]
Signature: ___________________________

Representative (If Company): [Name]
Title/Role: [Title]
Date: [Date]
Signature: ___________________________

[Business/Firm Name] Representative (Optional): [Name]
Title/Role: [Title]
Date: [Date]
Signature: ___________________________