Client Intake Form Template

CLIENT INTAKE FORM
{{business_name}}

PERSONAL INFORMATION
Name: _______________
Email: _______________
Phone: _______________
Address: _______________
Date of Birth: _______________
Preferred Contact Method: ☐ Phone ☐ Email ☐ Text

APPOINTMENT INFORMATION
Service Requested: _______________
How did you hear about us? _______________
Preferred Days: ☐ Mon ☐ Tue ☐ Wed ☐ Thu ☐ Fri ☐ Sat ☐ Sun
Preferred Times: ☐ Morning ☐ Afternoon ☐ Evening

ADDITIONAL INFORMATION
{{custom_question_1}}: _______________
{{custom_question_2}}: _______________
{{custom_question_3}}: _______________

Any allergies or special considerations? _______________

POLICIES
☐ I agree to the cancellation policy
☐ I consent to receive appointment reminders

Signature: _______________ Date: _______________