Agoraphobia Therapy Intake Form

Streamline Your Agoraphobia Assessment with Paperform

Agoraphobia is a complex anxiety disorder that requires careful, thorough assessment before beginning treatment. This Agoraphobia Therapy Intake Form template helps mental health professionals, therapists, and counselors gather comprehensive information about clients experiencing agoraphobia-related symptoms—all in one organized, compassionate digital form.

Why This Template Works for Mental Health Professionals

Instead of juggling paper forms, clipboards, and manual data entry, this template captures everything you need before the first session: panic attack history, specific feared situations, avoidance behaviors, safety behaviors, and the impact on daily functioning. The form uses conditional logic to reveal relevant follow-up questions based on client responses, creating a personalized intake experience that feels thoughtful rather than overwhelming.

Because Paperform works like editing a document, you can easily customize questions to match your therapeutic approach—whether you're practicing CBT, exposure therapy, or another modality. Add your practice branding, adjust the language to match your clinical style, and embed the form directly on your website or send it as a secure link before appointments.

Built for Therapy Workflows

This template integrates seamlessly into your practice management workflow. Connect submissions to your CRM, practice management software, or Google Sheets to keep client information organized. Use Paperform's conditional confirmations to send personalized welcome messages with pre-session instructions or intake packet materials.

For practices handling sensitive mental health information, Paperform offers SOC 2 Type II compliance and data security features to help protect client confidentiality—though please note that Paperform is not HIPAA compliant, so evaluate whether this platform meets your specific regulatory requirements.

Automate Your Intake Process with Stepper

Want to take your intake workflow further? Connect this form to Stepper to automatically create client records in your practice management system, send appointment reminders, generate personalized treatment plans, or trigger welcome email sequences—all without manual follow-up. This means you can spend less time on administrative tasks and more time focused on client care.

Who This Template Is For

This Agoraphobia Therapy Intake Form is ideal for therapists, clinical psychologists, licensed counselors, anxiety specialists, and mental health clinics working with clients who experience agoraphobia, panic disorder, or related anxiety conditions. It's designed to help you gather detailed clinical information efficiently while creating a professional, empathetic first impression.