Student intake form

Updated 2026-10-30 · By Meera Manikandan, Counselling Psychologist, Counseld

In shortAt a first meeting, record five things: how the student came to you, that you explained confidentiality (and how), the student’s story in their own words, their strengths and support, and a 0–10 rating of today. Use it as a guide, not an interview script.

From practice Use this as a guide, not an interview script. Follow the student’s lead. You don’t need every box on day one.

Student name or code

Class and section

Age

Date of first session

1How they came to you

SelfTeacherParentPrincipal or coordinatorPeerOther

Reason given by the person who referred

2Confidentiality explained

Limits explained in age-appropriate wordsStudent said it back in their own wordsQuestions answered

How I explained it (one line)

3In the student’s own words

“What brings you here today?”

“If things got a little better, what would be different?”

4Strengths and support

What’s going well

People who help (home, school, friends)

Interests and things they enjoy

5Today on a scale of 0 to 10

012345678910

0 = the worst it’s been, 10 = how they’d like things to be.

Need wording for step 2? The First-Year Starter Guide has confidentiality wording for every age group.

Rather go paperless? Record intake in Counseld.

Add the student once and their profile keeps these details: class, and who referred them and why. After the session, speak or type for two minutes and the first note is structured and saved to that profile.

Try Counseld

Counseld Documentation Toolkit · Not a substitute for supervision, school policy or legal advice.

Get the printable toolkit

All 9 pages as a print-ready PDF: the WORDS rules, the teacher referral slips, the intake form and the psychosocial check-in. Free.

Download the PDF