Private-practice client intake checklist template

1. Immediately route urgency and safety signals

   On receipt, if information may indicate urgent or emergency handling is needed, use the practice’s approved immediate process; do not wait for the proposed appointment or use this task board for monitoring.

   Urgent priority
   • □ Approved immediate-response owner is alerted
   • □ Task board is not relied on for emergency monitoring

2. Create a neutral inquiry reference

   Create the prospective-client record in the approved system and use only its neutral reference for task coordination here.

   High priority 7 days before proposed first appointment
   • □ Approved source-system record is created
   • □ Operational tasks use a neutral reference only

3. Assign the response owner and target

   Name the person responsible for the next approved communication and record the practice response target and contingency owner.

   Medium priority 7 days before proposed first appointment
   • □ Response owner accepts the handoff
   • □ Response target and contingency path are set

4. Send approved intake expectations

   Use the practice-approved channel and copy to explain the intake process, response timing, emergency boundary, and next required action.

   High priority 6 days before proposed first appointment
   • □ Communication uses the approved channel
   • □ Timing and emergency boundaries are included

5. Confirm minimum administrative inputs

   Verify in the approved system that only the minimum information needed for authorized routing and scheduling review is available.

   Medium priority 6 days before proposed first appointment
   • □ Required administrative inputs are present
   • □ Clinical detail is not copied into operational tasks

1. Route the authorized fit and scope review

   Assign the inquiry to the qualified practice owner who decides scope, suitability, licensure, capacity, and any required escalation.

   High priority 5 days before proposed first appointment
   • □ Qualified decision owner is assigned
   • □ Decision is preserved in the approved record

2. Confirm service and payment boundaries

   Have authorized owners confirm service format, availability, fees, payment method, and insurance or referral workflow where applicable.

   Medium priority 4 days before proposed first appointment
   • □ Service boundaries are confirmed by the owner
   • □ Approved payment or coverage path is confirmed

3. Record the intake decision and next path

   Record the authoritative proceed, wait, refer, or not-accepted outcome in the approved system and assign its communication owner.

   High priority 3 days before proposed first appointment
   • □ Authoritative intake outcome is recorded
   • □ Next communication has an accountable owner

1. Complete required notice and consent records

   Route practice-approved privacy, service, communication, consent, and acknowledgement records through their authoritative system.

   High priority 3 days before proposed first appointment
   • □ Required records are routed through approved systems
   • □ Completion status is authoritative outside this checklist

2. Complete approved payment setup

   Use the authorized payment or billing system to complete required setup without placing account, card, insurance, or financial details here.

   Medium priority 2 days before proposed first appointment
   • □ Setup uses the approved payment or billing system
   • □ Financial and coverage details stay out of tasks

3. Schedule the first appointment authoritatively

   Confirm date, format, location or approved connection method, clinician, reminders, cancellation terms, and time zone in the scheduling system.

   High priority 2 days before proposed first appointment
   • □ Appointment is in the authoritative schedule
   • □ Approved practical instructions are delivered

1. Verify first-appointment readiness

   Confirm required administrative records, clinician assignment, room or approved connection, accessibility arrangements, and contingency path.

   High priority 1 day before proposed first appointment
   • □ Required administrative records are ready
   • □ Visit logistics and contingency path are ready

2. Complete the post-appointment record check when a visit occurs

   When an appointment occurs, ask authorized owners to confirm the scheduling, payment, clinical, consent, and follow-up records required by practice procedure are current.

   High priority 1 day after proposed first appointment
   • □ Required source-system records are current
   • □ Outstanding follow-up has an accountable owner

3. Promptly complete the not-accepted closeout when applicable

   Promptly after a not-accepted decision, confirm approved communication, referral information where appropriate, record disposition, and removal of unnecessary access; do not wait for the proposed appointment.

   High priority
   • □ Authoritative communication status is recorded
   • □ Required record and access closeout is complete

Completion stage — move finished work here.