Polyamory Counseling Intake Form

Polyamory Counseling Intake Form: Build Healthier, More Connected Relationships

Polyamorous and consensually non-monogamous relationships come with unique joys and challenges. Whether you're navigating compersion and jealousy, establishing boundaries across multiple partnerships, or simply seeking support for your relationship structure, finding a therapist who truly understands ethical non-monogamy is essential.

This Polyamory Counseling Intake Form is designed specifically for mental health professionals who work with polyamorous, open, and consensually non-monogamous clients. It helps you gather comprehensive information about your clients' relationship structures, communication patterns, boundaries, and therapeutic goals—all before the first session begins.

Why This Template Works for Polyamory-Affirming Therapists

Traditional relationship intake forms often assume monogamy, leaving polyamorous clients feeling unseen or misunderstood. This template takes a different approach. It's built to:

• Honor diverse relationship structures – from triads and quads to kitchen table polyamory, parallel polyamory, and relationship anarchy
• Explore communication across multiple partners – understanding how your clients navigate scheduling, emotional processing, and conflict resolution with various partners
• Assess jealousy and compersion – moving beyond shame to explore the full emotional landscape of polyamorous relationships
• Clarify boundaries and agreements – identifying where boundaries are working and where they need support
• Identify specific therapeutic goals – tailored to the unique needs of consensually non-monogamous relationships

By using Paperform, you can create an intake experience that feels warm, professional, and fully aligned with your practice's values. The form can match your brand colors and fonts, embed directly into your website, and provide clients with a welcoming first touchpoint that affirms their relationship choices.

What's Included in This Polyamory Counseling Intake Form

This template covers all the essential areas you need to understand your polyamorous clients:

Client Demographics & Background – Name, contact information, pronouns, and basic background to ensure respectful, affirming communication from day one.

Relationship Structure & History – Questions about current relationship configurations, how long they've been practicing polyamory, and their journey into consensual non-monogamy. This helps you understand whether they're new to polyamory or have years of experience, and whether they're dealing with transition challenges or long-term relationship dynamics.

Current Partners & Dynamics – A detailed section where clients can describe each significant relationship, including the nature of each partnership, living arrangements, and hierarchical or non-hierarchical structures. This gives you a clear picture of the relationship constellation before the first session.

Communication Patterns – How do your clients communicate with their partners? Do they have regular check-ins? How do they handle scheduling conflicts or competing needs? Understanding communication styles helps you identify strengths and growth areas early on.

Jealousy, Compersion & Emotional Processing – Polyamory often involves navigating complex emotions. This section explores how clients experience and manage jealousy, whether they experience compersion (joy at a partner's happiness with others), and what emotional support systems they have in place.

Boundaries & Agreements – Every healthy polyamorous relationship relies on clear, consensual agreements. This template asks about existing boundaries, agreements around safer sex practices, disclosure expectations, and areas where boundaries feel unclear or violated.

Therapeutic Goals & Expectations – What brings them to counseling? Are they dealing with a specific conflict, wanting to improve communication, processing a breakup within a polycule, or seeking support as they open up a previously monogamous relationship? Clear goals help you tailor your approach from session one.

How Therapists Use This Form with Paperform

Before the First Appointment – Send the form link via email or embed it on your practice website. Clients can complete it at their own pace, giving thoughtful answers without the pressure of an in-person intake interview.

Conditional Questions for Personalization – Use Paperform's conditional logic to show follow-up questions based on responses. For example, if a client indicates they're new to polyamory, you might ask about their transition experience. If they're experiencing a specific conflict, you can gather more details automatically.

Seamless Workflow Integration with Stepper – Once a client submits their intake form, you can use Stepper to automatically create their client file, send a confirmation email, add them to your calendar system, and notify your admin team—all without lifting a finger. This means less time on paperwork and more time providing compassionate, informed care.

eSignatures for Consent Forms – Pair this intake form with Papersign to gather informed consent, confidentiality agreements, and financial policies digitally. Everything stays connected to the original intake submission for a complete, organized client record.

Secure, Confidential Data Collection – Paperform is SOC 2 Type II compliant and offers robust security features, giving both you and your clients peace of mind that sensitive relationship information is protected.

Designed for Polyamory-Affirming Therapists, Counselors, and Coaches

This template is ideal for:

• Licensed therapists and counselors specializing in relationships, sex therapy, or LGBTQ+ affirming care
• Relationship coaches working with consensually non-monogamous clients
• Mental health professionals expanding their practice to serve polyamorous and ENM communities
• Group practices seeking intake forms that respect diverse relationship structures

Whether you're a solo practitioner or part of a larger counseling center, this form helps you demonstrate cultural competence and create a welcoming, affirming intake experience from the very first interaction.

Customizable, On-Brand, and Easy to Use

Every therapeutic practice is different, and your intake form should reflect your unique approach. With Paperform's document-style editor, you can easily:

• Add your practice logo and brand colors
• Adjust questions to match your therapeutic modality
• Include video welcome messages or educational resources
• Embed the form seamlessly on your website or share via direct link
• Export responses to your practice management software or Google Sheets

You don't need any coding skills—just edit the template like you would a document, and Paperform handles the rest.

Get Started with a Polyamory-Affirming Intake Process

Traditional intake forms weren't built for the complexity and beauty of polyamorous relationships. This template changes that. By using Paperform's flexible, secure platform, you can create an intake experience that honors your clients' relationship structures, gathers the information you need, and sets the foundation for effective, affirming therapy.

Ready to welcome polyamorous clients with an intake process that truly sees them? Start with this template and customize it to fit your practice perfectly.