RikBot — Client Intake Form

1 Your Practice

Practice name

As it appears on your website or Psychology Today profile

Your name and role

Your full name and title

Notification email

Where workflow alerts will be sent

Phone for SMS (optional)

Leave blank if email only is fine

How many therapists in your practice?

Including yourself

2 Your Current Intake Setup

Where do new client inquiries currently come from?

Check all that apply

If other, please describe

Where do intake submissions currently land?

Email address where intakes currently arrive

Do you currently use an EHR or practice management system?

If yes, which one and how long have you been using it?

3 Your Intake Form Fields

What information does your current intake form collect?

List all fields: e.g. name, phone, email, reason for seeking therapy, insurance, availability

Are there any fields that could indicate urgency or crisis?

e.g. a free-text reason field, or a question like "Are you having thoughts of self-harm?"

What specific language should trigger an immediate crisis flag?

Be as specific as you like. This is what the system will watch for.

4 Routing Preferences

When a standard intake comes in, who should be notified?

Just me Me and one other person Multiple therapists based on specialty Not sure, let's discuss

If routing to multiple therapists, what criteria should determine who gets it?

e.g. specialty (anxiety vs trauma), availability, caseload, insurance accepted

List each therapist's name, specialty, and notification email or phone

e.g. Dr. Kim, trauma, kim@practice.com

When a crisis intake comes in, who should be notified immediately?

Just me Me and one other person All therapists A dedicated on-call contact

Crisis notification contact name and email or phone

How would you like to be notified?

Email only SMS only Both email and SMS

5 Automated Response (Optional)

Would you like the system to send an automatic acknowledgment email to new clients?

Yes No Not sure, let's discuss

If yes, what should that acknowledgment say?

Write your preferred message or leave blank and I will draft something for your review

6 Access and Technical

Are you comfortable granting read access to the inbox where intakes land?

This is how the workflow reads incoming forms. I only request read permissions, never send or delete access.

Yes I need more information first I would prefer a different approach

Any other tools or platforms I should know about?

Even if you are not sure it is relevant, list it here

Anything about your current setup that feels complicated or unusual?

No wrong answers here

7 Timeline and Logistics

When would you ideally like the workflow live?

As soon as possible Within 2 weeks Within a month Flexible

Any dates or events to be aware of?

e.g. a staff change, website update, or busy period coming up

Preferred invoice method

Legal name for invoice

As it should appear on the invoice

Any questions or concerns before we get started?