The Therapy Client Intake Form serves as the primary documentation tool for initiating therapeutic relationships in Hong Kong's mental health sector. It is designed to meet the requirements of Hong Kong's healthcare regulations, particularly the Personal Data (Privacy) Ordinance and Mental Health Ordinance. This form should be used prior to commencing therapy services, collecting crucial information about the client's background, current concerns, and medical history while ensuring proper informed consent and data protection protocols are followed. The document is structured to support mental health professionals in making initial assessments while maintaining compliance with local regulatory requirements and professional standards. It includes provisions for risk assessment, emergency contacts, and clear documentation of the therapeutic relationship terms.
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1. Personal Information: Client's basic details including name, contact information, date of birth, and preferred contact method
2. Emergency Contact Information: Details of primary and secondary emergency contacts
3. Medical History: Current and past medical conditions, medications, and treating physicians
4. Mental Health History: Previous therapy experiences, psychiatric care, and relevant diagnoses
5. Current Concerns: Primary reasons for seeking therapy and current symptoms
6. Risk Assessment: Basic screening for self-harm, suicide risk, and harm to others
7. Privacy Notice: Information about how personal data will be collected, used, and protected as per PDPO requirements
8. Consent Declaration: Client's acknowledgment and consent to treatment and data processing
9. Payment Information: Fee structure, payment methods, and insurance details if applicable
1. Cultural Background: Optional section for collecting information about cultural factors that may influence therapy, relevant for multicultural practice
2. Family History: Detailed family mental health history, optional unless specifically relevant to treatment approach
3. Substance Use Assessment: Detailed substance use history, included when relevant to treatment or suspected as a concern
4. Educational/Occupational History: Background information about education and work, included when relevant to treatment goals
5. Legal History: Information about current or past legal issues, included when relevant to treatment context
1. Schedule A: Detailed Symptom Checklist: Comprehensive checklist of psychological symptoms for baseline assessment
2. Schedule B: Privacy Policy: Detailed privacy policy and data handling procedures as required by PDPO
3. Schedule C: Fee Schedule: Detailed breakdown of fees, cancellation policies, and payment terms
4. Schedule D: Crisis Management Plan: Emergency procedures and contact information for crisis situations
5. Appendix 1: Client Rights and Responsibilities: Detailed explanation of client rights, responsibilities, and therapy boundaries
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