Therapy Intake Form for Malta

Therapy Intake Form Template for Malta

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Therapy Intake Form

"I need a Therapy Intake Form for my new private psychology practice in Malta opening in March 2025, focusing on adult clients with anxiety and depression, including options for both in-person and online therapy sessions."

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What is a Therapy Intake Form?

The Therapy Intake Form is a critical document used at the commencement of therapeutic services in Malta, serving as both a clinical and legal instrument. It must comply with the Maltese Mental Health Act, Healthcare Professions Act, and EU GDPR requirements. This document is typically completed during or before the first therapy session, collecting essential information about the client's personal details, medical history, mental health concerns, and emergency contacts. The form includes necessary consent declarations and privacy notices, establishing the framework for the therapeutic relationship while protecting both the client's and practitioner's interests. It serves as a foundation for treatment planning and maintains compliance with regulatory requirements for mental health services in Malta.

What sections should be included in a Therapy Intake Form?

1. Personal Information: Basic client details including name, date of birth, contact information, and preferred contact method

2. Emergency Contact Information: Details of emergency contacts and their relationship to the client

3. Medical History: Current and past medical conditions, medications, and treating physicians

4. Mental Health History: Previous mental health treatment, hospitalizations, and current mental health concerns

5. Current Symptoms: Checklist and description of current symptoms and their severity

6. Risk Assessment: Questions regarding self-harm, suicide risk, and violence risk assessment

7. Privacy Notice: GDPR-compliant privacy notice explaining how personal data will be collected, used, and protected

8. Consent for Treatment: Informed consent section outlining therapy process, risks, benefits, and client rights

9. Financial Agreement: Session fees, payment policies, and cancellation procedures

10. Communication Policy: Guidelines for between-session communication and emergency procedures

What sections are optional to include in a Therapy Intake Form?

1. Insurance Information: Details of health insurance coverage, if applicable for private practice

2. Medication List: Detailed current medication list, required if client is taking multiple medications

3. Family History: Family mental health history, included when relevant to treatment

4. Substance Use Assessment: Detailed substance use history, included when relevant to presenting problems

5. Cultural/Religious Considerations: Information about cultural or religious factors that may impact therapy

6. Recording Consent: Additional consent for session recording if used for training or supervision purposes

7. Telehealth Consent: Additional consent and protocols for online therapy services if offered

What schedules should be included in a Therapy Intake Form?

1. Symptom Checklist: Standardized checklist of mental health symptoms

2. Fee Schedule: Detailed breakdown of therapy fees and payment options

3. Privacy Policy: Detailed GDPR-compliant privacy policy and data protection procedures

4. Crisis Resources: List of emergency mental health resources and contact information

5. Client Rights Document: Detailed explanation of client rights under Maltese law

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 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

Mental Health Services

Social Services

Education

Corporate Wellness

Private Practice

Public Health

Employee Assistance Programs

Relevant Teams

Mental Health

Clinical Administration

Healthcare Operations

Compliance

Data Protection

Medical Records

Patient Services

Quality Assurance

Legal

Information Technology

Relevant Roles

Psychotherapist

Clinical Psychologist

Counselor

Psychiatrist

Mental Health Nurse

Social Worker

Practice Manager

Healthcare Administrator

Compliance Officer

Data Protection Officer

Medical Records Manager

Mental Health Practice Owner

Clinical Director

Intake Coordinator

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