Medium

Available on

Apple Android Windows

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

Want to learn more about GoCanvas?

Request a Demo

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.'}}

  • {{data.title}}

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!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

New Customer Form

This new customer form mobile app provides simple new customer forms for service based companies such as dry cleaning, law...

App Name

School Injury Report - Simple Version

If you're a staff member at a school the School Injury Report Mobile App is perfect for collecting key accident/injury inf...

App Name

OSHA - Notice of Alleged Safety Viola...

"OSHA inspections for occupational safety can reveal health hazards and even imminent danger. This mobile app for the comp...

App Name

Parking Citation

The Parking Citation mobile app for police departments and parking services professionals makes it possible to generate ne...

App Name

Natural Gas - Pipeline Survey

The Natural Gas Pipeline Survey mobile app was designed specifically for the natural gas industry. Instead of using paper ...

App Name

VA Dem House Race - Political Canvass...

This VA Dem House Race Political Canvassing Form was developed to be an electronic form of a survey sent out by the Virgin...

App Name

Road Construction and Equipment Tracking

The Road Construction and Equipment Tracking mobile app for construction managers and road crews tracks employee time shee...

App Name

Apparel Retail Form

This handy apparel retail form mobile app was built for a mobile retail sales associate or sales assistant. Great for depa...

More Information