Basic Intake Form

Basic Intake Form Template for New Zealand

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Key Requirements PROMPT example:

"I need a Basic Intake Form for my physiotherapy practice in Auckland, New Zealand, that includes sections for medical history and ACC claims, while ensuring compliance with healthcare privacy regulations and the Privacy Act 2020."

Document background

The Basic Intake Form serves as a fundamental tool for organizations in New Zealand to gather essential information from new clients or service users. This document is designed to comply with New Zealand's Privacy Act 2020 and related legislation, ensuring proper collection and handling of personal information. The form is typically used at the commencement of a service relationship, capturing crucial details such as personal information, contact details, emergency contacts, and service-specific requirements. The Basic Intake Form can be customized for various sectors while maintaining core compliance elements, making it suitable for healthcare providers, educational institutions, social services, and other professional service organizations. It includes necessary privacy statements and consent mechanisms, reflecting New Zealand's legal requirements for data protection and information handling.

Suggested Sections

1. Privacy Statement: Required statement explaining how personal information will be collected, used, stored, and shared, in compliance with the Privacy Act 2020

2. Personal Details: Basic identification information including full name, date of birth, contact details, and preferred contact method

3. Contact Information: Detailed contact information including physical address, postal address (if different), email, phone numbers

4. Emergency Contact: Details of at least one emergency contact person including their relationship to the client

5. Identification Verification: Section for recording details of identification documents provided (e.g., passport, driver's license)

Optional Sections

1. Medical Information: Optional section for collecting relevant medical history, conditions, or allergies when the service involves physical activity or health considerations

2. Cultural Considerations: Optional section for collecting information about cultural needs or preferences, particularly relevant for services involving personal care or cultural sensitivity

3. Payment Information: Optional section for collecting payment details or billing preferences when the service involves regular payments

4. Service-Specific Requirements: Optional section for collecting information specific to particular services or programs being accessed

5. Accessibility Requirements: Optional section for collecting information about any accessibility needs or accommodations required

Suggested Schedules

1. Privacy Policy: Detailed privacy policy document explaining how personal information is handled, stored, and protected

2. Consent Forms: Standard consent forms for information sharing and service provision

3. Terms and Conditions: Standard terms and conditions applicable to the service being provided

4. Information Sheet: Additional information about services, programs, or support available to the client

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 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

Education

Social Services

Professional Services

Community Services

Financial Services

Legal Services

Non-profit Organizations

Government Services

Mental Health Services

Disability Support Services

Relevant Teams

Administration

Client Services

Operations

Customer Support

Enrollment

Intake Processing

Compliance

Data Protection

Front Desk

Patient Services

Relevant Roles

Administrative Assistant

Office Manager

Intake Coordinator

Client Services Manager

Practice Manager

Operations Manager

Customer Service Representative

Program Coordinator

Social Worker

Healthcare Administrator

Enrollment Officer

Service Coordinator

Compliance Officer

Data Protection Officer

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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