Child & Adolescent Mental Health Intake Form

Child & Adolescent Mental Health Intake Form

Supporting the mental health of children and adolescents requires a comprehensive understanding of their developmental journey, family environment, and daily experiences. This Child & Adolescent Mental Health Intake Form is designed for therapists, counselors, psychologists, and pediatric mental health practices to gather the detailed information needed to provide personalized, effective care.

Why this form is essential for mental health practitioners

When working with young people, context is everything. A child's behavior doesn't exist in isolation—it's shaped by their developmental milestones, school experiences, family dynamics, peer relationships, and environmental factors. This intake form brings all of those pieces together in one structured, compassionate assessment that helps you:

• Understand the whole child: Capture developmental history, medical background, and current concerns in a format that reveals patterns and potential contributing factors
• Build trust from the start: Create a welcoming, professional first impression with a thoughtfully designed form that respects the sensitivity of mental health care
• Save valuable session time: Gather essential background information before the first appointment, allowing you to focus on building rapport and beginning therapeutic work
• Support accurate diagnosis and treatment planning: Document presenting concerns, symptom duration, previous interventions, and family history to inform clinical decisions
• Streamline practice operations: Replace paper files and scattered intake documents with organized digital submissions that integrate with your practice management system

What makes this template work for your practice

This form template is built specifically for the unique needs of child and adolescent mental health services. It covers:

Demographic and contact information including parent/guardian details, emergency contacts, and who has consent to make treatment decisions

Presenting concerns with space to describe current behavioral, emotional, or social challenges in the parent's own words

Developmental history tracking prenatal and birth history, early milestones, speech and language development, and any delays or concerns

Medical and psychiatric history documenting previous diagnoses, medications, hospitalizations, and any family history of mental health conditions

School performance and social functioning assessing academic progress, peer relationships, behavioral concerns at school, and any IEPs or 504 plans

Family dynamics exploring family structure, relationships between family members, parenting approaches, and any significant life events or stressors

Daily functioning including sleep patterns, eating habits, screen time, and any concerning behaviors like aggression, withdrawal, or self-harm

Previous treatment noting any prior therapy, counseling, or interventions and their effectiveness

The form uses conditional logic to show follow-up questions only when relevant, keeping the experience streamlined while capturing depth where needed. For example, if a parent indicates their child has received previous mental health treatment, additional fields appear to gather details about providers, duration, and outcomes.

Designed for healthcare professionals serving children and families

This template is ideal for:

• Child psychologists and psychiatrists conducting initial evaluations for diagnostic assessments
• Licensed therapists and counselors specializing in children, teens, and family therapy
• School counselors and social workers coordinating care for students with mental health needs
• Pediatric practices offering integrated behavioral health services
• Community mental health centers providing accessible care to young people
• Telehealth providers gathering comprehensive intake information for virtual sessions

Seamless integration with your clinical workflow

Paperform makes it easy to embed this intake form on your practice website, send it directly to families via email, or include it in your booking confirmation flow. All submissions are stored securely and can be automatically routed to your EHR system, Google Drive, or other practice management tools via Stepper workflows.

For practices managing multiple providers or locations, you can use conditional logic to route submissions to the appropriate therapist based on specialization, availability, or insurance accepted. Set up automated email confirmations that include next steps, office policies, and appointment details to reduce administrative back-and-forth.

With Papersign, you can turn this intake form into a complete onboarding package by automatically generating consent forms, treatment agreements, and HIPAA authorizations that families can sign electronically—keeping everything connected and compliant.

Supporting better outcomes through better intake

The quality of your intake process sets the tone for the entire therapeutic relationship. When families feel heard, understood, and supported from their very first interaction, they're more likely to engage fully in treatment. This form helps you demonstrate your commitment to comprehensive, family-centered care while capturing the clinical information you need to make informed decisions.

Whether you're a solo practitioner building a specialized practice or part of a larger behavioral health organization, this template adapts to your workflow. Customize questions to reflect your therapeutic approach, add your practice branding, and adjust conditional logic to match your assessment protocols.

Ready to streamline your child and adolescent intake process?

Get started with this template today and experience how Paperform helps mental health professionals deliver better care through better forms. With built-in HIPAA-level security (via SOC 2 Type II compliance), intuitive design, and powerful automation capabilities, you can focus on what matters most—supporting the young people and families who need your expertise.

Create forms that feel as thoughtful as the care you provide. Because every child deserves to be fully seen, understood, and supported on their journey toward better mental health.