Client Intake Assessment Form Template for New Zealand

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Key Requirements PROMPT example:

Client Intake Assessment Form

"I need a Client Intake Assessment Form for my mental health practice in Auckland, with particular emphasis on cultural sensitivity and privacy protection for Māori clients, to be implemented by March 2025."

Document background

The Client Intake Assessment Form serves as a crucial first point of contact between service providers and new clients in New Zealand. This document is designed to collect comprehensive information about clients while ensuring compliance with the Privacy Act 2020, Human Rights Act 1993, and other relevant New Zealand legislation. It is typically used at the commencement of a service relationship to gather essential personal information, assess service needs, identify potential risks, and obtain necessary consents. The form includes provisions for privacy protection, cultural considerations, and specific service requirements, making it adaptable across various professional sectors while maintaining legal compliance.

Suggested Sections

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

2. Contact Details: Address (residential and postal if different), phone numbers, email, and emergency contact information

3. Identity Verification: Details of identification documents provided to comply with AML/CFT requirements where applicable

4. Service Requirements: Primary reason for seeking services and immediate needs assessment

5. Risk Assessment: Initial evaluation of any risks or urgent concerns that need immediate attention

6. Privacy Statement: Information about how client data will be collected, stored, used and shared, in compliance with the Privacy Act 2020

7. Client Consent: Declarations and permissions for information collection, storage, and sharing

Optional Sections

1. Medical Information: Health conditions, medications, and medical history - include when services may be affected by health status

2. Cultural Considerations: Cultural identity, language preferences, and specific cultural needs - important for ensuring culturally appropriate service delivery

3. Financial Information: Income details, financial circumstances - include when services involve financial planning or means-testing

4. Legal Status: Information about legal representatives, power of attorney, or court orders - include when relevant to service provision

5. Support Services: Details of other agencies or professionals involved in client's care - include for complex cases requiring multi-agency coordination

Suggested Schedules

1. Schedule A - Service Specific Assessment: Detailed questionnaire relevant to specific service type being sought

2. Schedule B - Risk Management Plan: Detailed plan for managing identified risks, to be completed if risks are identified in initial assessment

3. Appendix 1 - Privacy Policy: Detailed privacy policy and information handling procedures

4. Appendix 2 - Client Rights and Responsibilities: Comprehensive outline of client rights, responsibilities, and complaint procedures

5. Appendix 3 - Fee Schedule: Details of service fees and payment arrangements if applicable

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

Social Services

Legal Services

Financial Services

Mental Health Services

Education

Professional Services

Disability Support Services

Aged Care Services

Community Services

Relevant Teams

Intake

Client Services

Administration

Compliance

Risk Management

Quality Assurance

Front Office

Operations

Legal

Privacy

Relevant Roles

Intake Coordinator

Case Manager

Service Manager

Client Services Officer

Administrative Assistant

Compliance Officer

Privacy Officer

Professional Services Provider

Social Worker

Healthcare Professional

Legal Professional

Financial Advisor

Risk Assessment Officer

Quality Assurance Manager

Find the exact document you need

Simple Intake Form

A New Zealand-compliant intake form for collecting and managing client information, structured according to NZ privacy laws and business requirements.

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Authors

Alex Denne

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