Client Intake and Consent Form
A new client form for a wellness or allied health practice that collects contact and health details and records consent to the service and the cancellation policy. Only the client signs.
For the United States, Canada, the United Kingdom and Australia.
The PDF is free to download. Centilio Sign is free to start.
What it covers
The template has 4 parts.
- Client details
- Health information
- Consent
- Cancellation policy
What you will be asked
Have these details ready. The template needs them before anyone signs.
- What service is the client booking?
- Who is the practitioner?Optional
Who signs
Everyone the template names, and what each one does.
- ClientSigns
Where it fits
For practices such as massage, physiotherapy, chiropractic, acupuncture or personal training taking on a new client. Medical clinics may need their own patient registration and treatment consent forms.
Before you rely on it
Original Centilio wording, not legal advice. Health privacy law where the practice is, such as HIPAA, PIPEDA and provincial health privacy acts, UK GDPR or the Australian Privacy Principles, may require a privacy notice and set rules for keeping these records. Check those and the consent rules for your profession before you approve it.
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US