Intake Information Form Template
By
Amy Caitlin de Wet
| Reviewed by
Dr Sabina Alispahic (PhD)
The contents of this article are fact-based except otherwise stated within the article.
Author bio
Amy de Wet is an Educational Psychologist with a special interest in psychological assessments, child psychology, and trauma.
Amy de Wet’s Highlights:
- Presenting at an International Conference regarding traumatic brain injury and expressive arts therapy ( Russia 2016)
- Master’s in Educational Psychology from the University of Johannesburg
- Working within the field of Neurodiversity and mental health
Professional experience
Amy de Wet works in varied settings offering valuable psychotherapeutic services to children, adolescents, adults, and their families. Focusing on school-related communities, Amy works directly with her clients, offering safety and containment as they process their internal and external worlds. Amy also works within the Neurodiverse community offering training, therapy, and support for parents, teachers, and individuals with neurodiversity. Amy believes in the use of expressive arts in the work that she does and incorporates this beneficial medium into her work. Amy draws from a variety of theories including psychoanalytic, DBT, CBT, and mindfulness.
Certifications
Lefika La’Phodisa: Community Art Counselling Certificate
Speech and Drama College South Africa: Speech and Drama Teacher Licentiate
Education
University of Johannesburg: Master’s in Educational Psychology (cum laude)
University of South Africa: Honours in Psychology
University of Witwatersrand: Bachelors in Performing and Visual Arts
LinkedIn Profile: www.linkedin.com/in/amy-de-wet-65188b64
Reviewer bio
Dr Sabina Alispahic, PhD, is a psychologist and gestalt psychotherapist with expertise in clinical and health psychology.
Dr Sabina Alispahic’s Highlights:
- Associate Professor at the University of Sarajevo for the past 12 years
- PhD in psychology at the University of Zagreb
- European Certificate of Psychotherapy
Professional experience
Dr Alispahic pioneered innovative teaching methods as an associate professor of clinical and health psychology, inspiring a new generation of mental health professionals while contributing to the field for over 12 years. Also, she empowered individuals across the globe as an online psychotherapist, delivering life-changing therapy and earning a reputation for compassionate care and exceptional results. She has demonstrated expertise in a range of therapeutic approaches (CBT, ACT, Gestalt, mindfulness, and family constellations).
Certifications
European Certificate of Psychotherapy (Education in Gestalt Psychotherapy Training of the Malta Institute)
Eight-week stress reduction mindfulness programme, Society of Psychologists in the Federation of Bosnia and Herzegovina
Education
2009-2013 University of Zagreb, Faculty of Philosophy, Postgraduate Doctoral Studies in Psychology
2004-2008 University of Sarajevo, Faculty of Philosophy, Master Studies, Department of Psychology
Publications
Books
Alispahic. S. (2021). Selected topics from psychotherapy Sarajevo: TDP.
Alispahic. S. (2020). Online psychotherapy. Handbook for psychotherapists and clients Sarajevo: TDP.
Alispahic, S., and Godinjak, A. (2018). (R)evolution of the doctor-patient relationship. Sarajevo: TDP.
Alispahic, S. (2016). The psychology of pain Sarajevo: Faculty of Philosophy (e-publication, Bosnian language): https://ebooks.ff.unsa.ba/index.php/ebooks_ffunsa/catalog/book/29
Book chapters
Alispahic, S. (2018). Psychological Theory and Therapy of Traumatic Memory In: A. Hamburger (ur.), Trauma, Trust, and Memory: Social Trauma and Reconciliation in Psychoanalysis, Psychotherapy, and Cultural Memory, 23-35. London and New York: Routledge, Taylor & Francis Group.
Markovic Pavlovic, M., Alispahic, S., and Dautbegovic, A. (2015). Psychology of Nonkilling in Bosnia-Herzegovina. Knowledge and Attitudes of Students Towards Nonkilling Culture. In: R. Bahtijaragic i J. E. Pim (ur.), Nonkilling Balkans, 171-183. Honolulu: Centre for Global Nonkilling, and Sarajevo: Faculty of Philosophy.
Link: http://nonkilling.org/pdf/nkbalkans.pdf
Articles
Alispahic, S., & Alispahic, B. (2021). Definition of police psychology: The role of psychologists in the police. Technium Soc. Sci. J., 17, 235-244.
Link: https://techniumscience.com/index.php/socialsciences/article/view/2678
Alispahic, S., Hasanbegovic-Anic, E., & Tuce, Đ. (2021). Big Five Personality Traits as Predictors of Mindfulness: A Study on a Bosnian Sample. Epiphany, 14(1), 146-155.
Link: http://epiphany.ius.edu.ba/index.php/epiphany/article/view/357
Alispahic, S. & Hodžić Küreç, A. (2021). How does yoga affect health? Yoga teachers’ experiences. International Scientific Journal of Kinesiology, Vol. 12, 2, 135-140.
Hasanbegovic-Anic, E., Sandic, A., and Alispahic, S. (2018). Prevention of substance abuse in children and adolescents: an evidence-based practice approach. Epiphany, 11(1), 11-30.
Link: http://epiphany.ius.edu.ba/index.php/epiphany/article/view/280
Alispahic, S. and Hasanbegovic-Anic, E. (2017). Mindfulness: Age and Gender Differences in a Bosnian Sample. Psychological Thought, Vol. 10 (1), 155–166.
Hadziahmetovic, N., Alispahic, S., Tuce, Đ., i Hasanbegovic-Anic, E. (2016). Therapist interpersonal style and therapy benefit as determinants of client personality self-reports in Bosnia and Herzegovina. Vojnosanit Pregl, 73 (2): 135–145.
Alispahic, S., Hasanbegovic-Anic, E., Tuce, Đ., Hadziahmetovic, N., Sandic, A. (2014). Characteristics of Patients Involved in Psychotherapy in Bosnia and Herzegovina. Journal of Health Sciences, 4 (1): 4-6.
Link: https://www.jhsci.ba/ojs/index.php/jhsci/article/view/142
Alispahic, S. (2013). Motivational function of plans and goals. Psychological Thought, Vol. 6 (2), 96–203.
Link: https://www.researchgate.net/publication/258225796_Motivational_Function_of_Plans_and_Goals
Professional profiles
ResearchGate: https://www.researchgate.net/profile/Sabina-Alispahic
Google Scholar: https://scholar.google.com/citations?hl=hr&user=TnYiVK0AAAAJ
LinkedIn: https://www.linkedin.com/in/sabina-alispahić/
Download Worksheet
Video & audio overview of the template
What is the theory behind the worksheet?
The intake of a new client is an in-depth process and must be well documented. This is a basic template for general intake information that a client can complete before their initial session. When the client moves into their initial session, more information will be gathered and recorded to gain a good understanding of their history.
How will the worksheet help?
Allowing for accurate information capturing maintains best practise throughout any mental health intervention.
This template provides a basis for the information a mental health practitioner will need to gather before they initiate a process with a client.
How to use the worksheet.
Important to note: This is a generalized template that provides a basic guideline on the information that needs to be gathered in an initial intake form. This should be tailored to ensure that it follows any requirements set by your specific governing board or association.
