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LAC/LAMFT Couples Intake Form Mobile App

LAC/LAMFT professionals will find this mobile application very useful in quickly gathering detailed information about couples while registering them for counselling sessions. App works on any mobile device and lets you capture specifics such as background information, emergency contacts, current living situation, family history, children living in home, presenting problem and more. Speed up this client intake form digitally and spend more time providing quality counselling sessions.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the LAC/LAMFT Couples Intake Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Date

  • Ico textbox

    Last Name

  • Ico textbox

    First Name

  • Ico textbox

    MI

  • Ico textbox

    SSN

  • Ico date

    Select DOB

  • Ico integer

    Age

  • Ico dropdown

    Sex

  • Ico textbox

    Ethnicity

  • Ico dropdown

    Marital Status

  • Ico integer

    Length Of Relationship (years)

  • Ico integer

    months

  • Ico multiline

    Address

  • Ico textbox

    City

  • Ico dropdown

    Select State

  • Ico integer

    Zip

  • Ico textbox

    Home Phone

  • Ico textbox

    Work Phone

  • Ico textbox

    Cell Phone

  • Ico textbox

    E-mail

  • Ico statictext

    Check if we can leave a message on your

  • Ico checkbox

    Home Phone

  • Ico checkbox

    Work Phone

  • Ico checkbox

    Cell Phone

  • Ico statictext

    Emergency Contact (If client is under 18 or under legal guardianship, list Parent/Guardian)

  • Ico textbox

    Last Name

  • Ico textbox

    First Name

  • Ico textbox

    MI

  • ...and More!

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