Client Intake Form for Healthcare & Allied Health

# Client Intake Form - Healthcare & Allied Health

## Purpose
Use at the start of every new client relationship to gather the information your team needs to deliver a great experience.

## When to Use
A professional client intake form that captures contact details, business information, goals, pain points, and preferred communication channels.

## Instructions
1. Review the template below and familiarise yourself with the structure
2. Replace all [bracketed placeholders] with your healthcare & allied health business details
3. Customise the tone and formatting to match your brand
4. Save in your preferred tool (HubSpot or Zapier)

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## Client Intake Form

**Purpose:** Capture all essential information at the start of a new client relationship to ensure your team can deliver a great experience from day one.

### Section 1: Contact Information
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Full Name | Text | Yes | Min 2 characters | Jane Smith |
| Email Address | Email | Yes | Valid email format | jane@company.com.au |
| Phone Number | Phone | Yes | Australian format | 04XX XXX XXX |
| Preferred Contact Method | Radio | Yes | - | Email / Phone / SMS |
| Best Time to Contact | Dropdown | No | - | Morning / Afternoon / No Preference |

### Section 2: Business Information
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| Business Name | Text | Yes | Min 2 characters | Acme Pty Ltd |
| ABN | Text | No | 11 digits | XX XXX XXX XXX |
| Industry | Dropdown | Yes | - | Select your industry |
| Website URL | URL | No | Valid URL format | https://www.example.com.au |
| Number of Employees | Dropdown | Yes | - | 1-5 / 6-20 / 21-50 / 51-100 / 100+ |
| Annual Revenue Range | Dropdown | No | - | Under $500K / $500K-$1M / $1M-$5M / $5M-$20M / $20M-$50M |
| Business Location | Text | Yes | - | Sydney, NSW |

### Section 3: Project Details
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| What service are you interested in? | Checkbox (multi-select) | Yes | Min 1 selected | Operations / Marketing / Technology / Strategy / Other |
| Describe your main business challenge | Textarea | Yes | Min 20 characters, Max 1000 | Tell us about the problem you are trying to solve... |
| What does success look like for you? | Textarea | No | Max 500 characters | Describe your ideal outcome... |
| Have you worked with a consultant before? | Radio | No | - | Yes / No |
| Budget Range | Dropdown | No | - | Under $5,000 / $5,000-$15,000 / $15,000-$50,000 / $50,000+ / Not sure yet |
| Desired Start Date | Date | No | Future date only | DD/MM/YYYY |

### Section 4: How Did You Find Us?
| Field | Type | Required | Validation | Placeholder |
|-------|------|----------|------------|-------------|
| How did you hear about us? | Dropdown | Yes | - | Google Search / Referral / Social Media / Event / Other |
| Referral Name (if applicable) | Text | No | - | Who referred you? |

### Conditional Logic
- If "Have you worked with a consultant before?" = "Yes", show additional field: "What worked well and what did not?" (Textarea)
- If "How did you hear about us?" = "Referral", show "Referral Name" field
- If "Budget Range" = "Not sure yet", show note: "No worries, we will discuss this during your free assessment."

### Submission
- **Button text:** "Submit Enquiry"
- **Confirmation message:** "Thank you for your enquiry. Our team will review your details and be in touch within one business day to schedule your free assessment."
- **Notification:** Send email to [Team Email] with all form data and tag as "New Lead" in CRM

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**Complexity:** simple | **Setup time:** 10 minutes | **Tools:** HubSpot, Zapier, Notion

Note: This template has been tailored for healthcare & allied health businesses in Australia. Adjust terminology and compliance references to match your specific context.