Client Intake Assessment Form

Client Intake Assessment Form Template for Philippines

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Key Requirements PROMPT example:

"I need a Client Intake Assessment Form for my mental health practice in Manila, compliant with Philippine healthcare regulations and data privacy laws, with special emphasis on patient confidentiality and emergency contact protocols."

Document background

The Client Intake Assessment Form serves as a crucial initial document for service providers operating in the Philippines to gather comprehensive information about potential clients while ensuring compliance with local regulations. This document is typically used at the beginning of a professional relationship to collect client details, assess service needs, and ensure proper due diligence. The form must comply with the Data Privacy Act of 2012 and other relevant Philippine regulations, making it essential for proper client screening and risk assessment. It includes sections for personal information, service requirements, risk assessment, and necessary disclosures, with additional modules for specific service types. The Client Intake Assessment Form helps organizations maintain consistent client onboarding processes while meeting regulatory requirements and professional standards.

Suggested Sections

1. Client Personal Information: Basic identification details including full name, contact information, and government-issued IDs in compliance with the Data Privacy Act

2. Service Requirements: Details of the specific services being sought and client's immediate needs

3. Client Background: Relevant historical information including previous service providers if applicable

4. Risk Assessment: Standard risk evaluation questions to identify potential issues or conflicts

5. Financial Information: Basic financial details relevant to service provision

6. Privacy Notice and Consent: Data privacy disclosures and consent forms as required by the Data Privacy Act

7. Declaration and Certification: Client's declaration of truth and accuracy of provided information

Optional Sections

1. Corporate Information: For business clients - includes company registration details, ownership structure, and authorized representatives

2. Medical History: For healthcare-related services - includes relevant medical background and current conditions

3. Employment Details: For employment-related services or when employment status is relevant to service provision

4. Emergency Contact Information: For services where emergency contacts might be needed

5. Special Needs Assessment: For clients requiring special accommodations or modifications to standard services

Suggested Schedules

1. Schedule A - Required Documents Checklist: List of required supporting documents based on service type

2. Schedule B - Fee Schedule: Standard fee structure and payment terms if applicable

3. Schedule C - Service Terms and Conditions: Detailed terms and conditions specific to the service being sought

4. Appendix 1 - Privacy Policy: Detailed privacy policy and data handling procedures

5. Appendix 2 - Consent Forms: Additional consent forms for specific service requirements

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

Legal Services

Healthcare

Financial Services

Professional Consulting

Real Estate

Insurance

Education

Social Services

Business Advisory

Accounting Services

Relevant Teams

Legal

Compliance

Client Relations

Risk Management

Data Protection

Operations

Administrative Support

Quality Assurance

Client Onboarding

Business Development

Service Delivery

Relevant Roles

Client Relations Manager

Compliance Officer

Risk Assessment Officer

Data Protection Officer

Legal Counsel

Business Development Manager

Operations Manager

Professional Service Provider

Client Onboarding Specialist

Quality Assurance Manager

Administrative Officer

Service Delivery Manager

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Authors

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