Client Intake Assessment Form

Client Intake Assessment Form Template for South Africa

Create a bespoke document in minutes, or upload and review your own.

4.6 / 5

4.8 / 5

Let's create your Client Intake Assessment Form

1. Select your governing law and document type:

2. Enter your key requirements:

3. Create your document to edit, review or download

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

"I need a Client Intake Assessment Form for my physiotherapy practice in Cape Town, with special focus on medical history collection and physical assessment sections, plus integration of medical aid information and HPCSA compliance requirements."

Document background

The Client Intake Assessment Form is a crucial document used by service providers in South Africa to gather and evaluate information about potential clients at the onset of a business relationship. This document is designed to ensure compliance with South African regulations, particularly the Protection of Personal Information Act (POPIA) and the Financial Intelligence Centre Act (FICA). It serves multiple purposes: collecting essential client information, assessing service needs, documenting consent for data processing, and establishing the foundation for service delivery. The form includes comprehensive sections for personal details, service requirements, risk assessment, and various optional modules that can be tailored to specific industry needs. It is particularly important for maintaining proper client records and ensuring regulatory compliance while facilitating effective service delivery.

Suggested Sections

1. Personal Information Collection Consent: POPIA-compliant consent section explaining purpose of data collection and processing

2. Client Personal Details: Basic information including full name, ID number, contact details, and address

3. Emergency Contact Information: Details of person to contact in case of emergency

4. Identity Verification: FICA compliance section for identity verification requirements

5. Service Requirements: Client's specific needs and service requirements

6. Medical History: Relevant medical information and conditions that may affect service delivery

7. Financial Information: Basic financial information relevant to service provision

8. Risk Assessment: Evaluation of potential risks and special considerations

9. Privacy Notice: Detailed information about how personal data will be used and protected

10. Declaration and Signature: Client's confirmation of accurate information and agreement to terms

Optional Sections

1. Insurance Information: Details of relevant insurance policies - include for healthcare or high-risk services

2. Dietary Requirements: Special dietary needs or restrictions - include for services involving food or extended care

3. Mobility Assessment: Evaluation of mobility needs - include for physical therapy or elderly care services

4. Payment Preferences: Preferred payment methods and billing arrangements - include for ongoing services

5. Previous Service History: History of similar services received - include when service continuity is important

6. Cultural Considerations: Specific cultural or religious requirements - include for personal care services

Suggested Schedules

1. Schedule A: Terms and Conditions: Detailed terms and conditions of service provision

2. Schedule B: Fee Structure: Breakdown of fees and payment terms

3. Schedule C: Privacy Policy: Detailed privacy policy and data protection measures

4. Appendix 1: Required Documentation Checklist: List of documents required for complete registration

5. Appendix 2: Service Level Agreement: Detailed description of service standards and expectations

6. Appendix 3: Consent Forms: Additional specific consent forms required for particular services

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

Legal Services

Financial Services

Professional Services

Education

Social Services

Healthcare Services

Consulting

Real Estate

Insurance

Wellness and Fitness

Elderly Care Services

Child Care Services

Mental Health Services

Relevant Teams

Client Services

Compliance

Risk Management

Operations

Legal

Administrative Support

Quality Assurance

Data Protection

Customer Relations

Onboarding

Business Development

Relevant Roles

Client Relations Manager

Intake Coordinator

Compliance Officer

Risk Assessment Officer

Customer Service Representative

Practice Manager

Administrative Assistant

Legal Compliance Manager

Data Protection Officer

Business Development Manager

Operations Manager

Service Coordinator

Quality Assurance Manager

Client Services Director

Onboarding Specialist

Find the exact document you need

Printable Facial Intake Form

A POPIA-compliant facial treatment intake and consent form for South African aesthetic practices, collecting essential client information and medical history.

��������Ƶ

How a Sales & Marketing Lead uses ��������Ƶ to reduce contract drafting time by 95%

Let's create your Client Intake Assessment Form

Authors

Alex Denne

Find the exact document you need

Printable Facial Intake Form

Holistic Intake Form

Mediation Intake Form

Health Coach Intake Form

Reflexology Intake Form

Counseling Intake Interview Form

Yoga Intake Form

Event Intake Form

Legal Intake Form

Event Planning Client Intake Form

Nutrition Intake Form

Counseling Intake Form

Project Intake Form

General Intake Form

Therapy Intake Form

Real Estate Lead Intake Form

Real Estate Client Intake Form

Phone Intake Form

Initial Intake Form

Client Intake Assessment Form

Cavitation Intake Form

Veterinary Intake Form

Financial Coaching Intake Form

Virtual Assistant Intake Form

Hypnotherapy Client Intake Form

Home Care Intake Form

Case Intake Form

Inventory Intake Form

Biopsychosocial Intake Form

Vehicle Intake Form

Real Estate Buyer Intake Form

Marriage Counseling Intake Form

Consulting Intake Form

Case Management Intake Form

Bookkeeping Client Intake Form

Salon Client Intake Form

Creative Intake Form

Esthetician Client Intake Form

Client Intake Form

Lead Intake Form

Employment Intake Form

Vendor Intake Form

Intake Assessment Form

Clinical Intake Form

Procurement Intake Form

Patient Intake Form

Download our whitepaper on the future of AI in Legal

�ұ�Ծ���’s Security Promise

Your documents are private:

Your documents are protected:

Organizational security

Innovation in privacy:

Want to know more?

Use Cases

��Ƶ

How a Sales & Marketing Lead uses ��Ƶ to reduce contract drafting time by 95%

�ұ�Ծ��’s Security Promise