About the Client Information Form

TherapyNotes LLC Therapy Portal Forms

This page is intended for potential or new clients, so they understand the Client Information Form, and why I collect the demographic information requested.

The Client Information Form is designed to gather key details needed for individualized and effective therapy services. When you complete the form, you are invited to provide information such as legal name, preferred name, pronouns, date of birth, contact information, and other demographic details. This data helps me streamline the intake process by making sure my records are accurate and that your personal preferences, identity, and background are respected.

Specifying information like pronouns, gender identity, and sexual orientation, allows me to tailor sessions in a way that acknowledges your unique needs and experiences, helping foster a respectful and empowering therapeutic environment. You can also note important details regarding phone usage and whether it is acceptable to leave voice messages, ensuring that communication remains discreet and upholds your preferred boundaries.

I assure you that I do my best to ensure that all personal information obtained in this form is handled securely and confidentially, aligning with privacy standards such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States. Any demographic details, including race, ethnicity, language, religious affiliation, and marital status, are gathered to better inform my approach, allowing for culturally sensitive and client-centered care.

Once you complete the form on Therapy Portal, the submitted information becomes part of your file in my electronic health records system and can be automatically merged into Therapy Notes, pending my approval. If you have any concerns or questions about certain fields, you are encouraged to speak with me so we can discuss how best to proceed, respecting your comfort level and personal choices.

Completing this form outside of the session helps me provide a seamless, personalized experience right from the start, reducing administrative hassle and freeing more time during therapy sessions to focus on your needs.

A detailed example of the information gathered:

Legal Name:
Preferred Name:
Pronouns:
Date of Birth:
Address 1:
Address 2:
Zip Code:
City:
State:
Mobile Phone:
Home Phone:
Work Phone:
Other Phone:
Administrative Sex:
Gender Identity:
Sexual Orientation:
Race:
Ethnicity:
Languages:
Marital Status:
Employment:
Religious Affiliation:
Smoking Status: