Marriage Counseling Intake Form

Marriage Counseling Intake Form Template for Philippines

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Key Requirements PROMPT example:

"I need a Marriage Counseling Intake Form for my new counseling practice opening in Manila in January 2025, with digital form integration capabilities and compliance with the latest Philippine data privacy regulations."

Document background

The Marriage Counseling Intake Form is a crucial document used in Philippine mental health practices to initiate professional counseling services for couples or individuals seeking relationship support. This document is designed in accordance with Philippine regulations, including the Psychology Act of 2009 and the Data Privacy Act of 2012, ensuring both professional standards and legal compliance. The form collects comprehensive information about clients' personal details, relationship history, current concerns, and counseling goals, while incorporating necessary consent and confidentiality agreements. It serves as the foundation for establishing the therapeutic relationship and creating appropriate treatment plans, making it essential for both initial assessment and ongoing reference during the counseling process.

Suggested Sections

1. Client Information: Basic demographic information including name, age, date of birth, contact details, and preferred contact method

2. Emergency Contact Information: Details of person to contact in case of emergency during counseling sessions

3. Relationship Status: Current marital status, length of relationship/marriage, and basic information about spouse/partner

4. Presenting Concerns: Primary reasons for seeking counseling and current relationship challenges

5. Relationship History: Brief overview of relationship timeline, significant events, and previous counseling experiences

6. Medical and Mental Health History: Relevant medical conditions, current medications, and previous mental health treatment

7. Safety Assessment: Questions regarding domestic violence, self-harm, and immediate safety concerns

8. Goals for Counseling: Client's expectations and desired outcomes from the counseling process

9. Consent and Confidentiality: Agreement to counseling services and understanding of confidentiality limits

Optional Sections

1. Cultural/Religious Background: Information about cultural and religious factors that may influence the relationship and counseling process

2. Family of Origin Information: Details about family background and patterns that may impact current relationship

3. Substance Use Assessment: Questions about alcohol and drug use if relevant to relationship issues

4. Children and Parenting: Information about children, parenting challenges, and co-parenting dynamics if applicable

5. Financial Status: Basic financial information if money issues are a concern in the relationship

6. Sexual History: Information about intimate relationship aspects if relevant to presenting concerns

7. Previous Legal Issues: Information about any legal matters affecting the relationship

Suggested Schedules

1. Appendix A: Informed Consent Form: Detailed consent form outlining counseling procedures, rights, and responsibilities

2. Appendix B: Privacy Policy: Detailed explanation of how client information is handled and protected

3. Appendix C: Assessment Scales: Standardized relationship assessment tools and scoring guides

4. Appendix D: Crisis Resources: List of emergency contacts and crisis intervention resources

5. Appendix E: Fee Schedule: Breakdown of counseling fees and payment policies

6. Appendix F: Release of Information Form: Optional form for authorizing information sharing with other professionals

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Mental Health Services

Social Services

Professional Services

Family Services

Legal Services

Healthcare Administration

Counseling and Therapy

Psychology Services

Relevant Teams

Clinical Operations

Mental Health Services

Counseling Services

Client Relations

Healthcare Administration

Quality Assurance

Legal Compliance

Records Management

Professional Services

Relevant Roles

Marriage Counselor

Clinical Psychologist

Family Therapist

Mental Health Practitioner

Relationship Counselor

Healthcare Administrator

Practice Manager

Clinical Director

Intake Coordinator

Mental Health Social Worker

Professional Counselor

Clinical Supervisor

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