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<!DOCTYPE html> <html dir="ltr" lang="en-US" prefix="og: https://ogp.me/ns#"> <head> <meta charset="UTF-8"> <title>Customizable Counseling Session Request Form Template</title>  <meta name="description" content="The Counseling Session Request Form template is designed to remove barriers to access, create clarity, and support individuals in finding the help they need." /> <meta name="robots" content="max-image-preview:large" /> <link rel="canonical" href="https://wpforms.com/templates/counseling-session-request-form-template/" /> <meta name="generator" content="All in One SEO Pro (AIOSEO) 4.7.0" /> <meta property="og:locale" content="en_US" /> <meta property="og:site_name" content="WPForms Form Template Gallery" /> <meta property="og:type" content="article" /> <meta property="og:title" content="Customizable Counseling Session Request Form Template" /> <meta property="og:description" content="The Counseling Session Request Form template is designed to remove barriers to access, create clarity, and support individuals in finding the help they need." /> <meta property="og:url" content="https://wpforms.com/templates/counseling-session-request-form-template/" /> <meta property="og:image" content="https://wpforms.com/templates/wp-content/uploads/2021/05/opengraph-02092021.png" /> <meta property="og:image:secure_url" content="https://wpforms.com/templates/wp-content/uploads/2021/05/opengraph-02092021.png" /> <meta property="og:image:width" content="2500" /> <meta property="og:image:height" content="1407" /> <meta property="article:published_time" content="2024-10-07T14:41:08+00:00" /> <meta property="article:modified_time" content="2024-10-07T14:41:08+00:00" /> <meta property="article:publisher" content="https://facebook.com/wpforms" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:site" content="@easywpforms" /> <meta name="twitter:title" content="Customizable Counseling Session Request Form Template" /> <meta name="twitter:description" content="The Counseling Session Request Form template is designed to remove barriers to access, create clarity, and support individuals in finding the help they need." /> <meta name="twitter:creator" content="@easywpforms" /> <meta name="twitter:image" content="https://wpforms.com/templates/wp-content/uploads/2021/05/opengraph-02092021.png" /> <meta name="twitter:label1" content="Written by" /> <meta name="twitter:data1" content="Kacie Cooper" /> <meta name="twitter:label2" content="Est. reading time" /> <meta name="twitter:data2" content="2 minutes" /> <script type="application/ld+json" class="aioseo-schema"> {"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/wpforms.com\/templates\/counseling-session-request-form-template\/#article","name":"Customizable Counseling Session Request Form Template","headline":"Counseling Session Request Form Template","author":{"@id":"https:\/\/wpforms.com\/templates\/author\/kcooper\/#author"},"publisher":{"@id":"https:\/\/wpforms.com\/templates\/#organization"},"image":{"@type":"ImageObject","url":"https:\/\/wpforms.com\/templates\/wp-content\/uploads\/2021\/05\/wpformslogo.png","@id":"https:\/\/wpforms.com\/templates\/#articleImage","width":549,"height":163},"datePublished":"2024-10-07T10:41:08-04:00","dateModified":"2024-10-07T10:41:08-04:00","inLanguage":"en-US","mainEntityOfPage":{"@id":"https:\/\/wpforms.com\/templates\/counseling-session-request-form-template\/#webpage"},"isPartOf":{"@id":"https:\/\/wpforms.com\/templates\/counseling-session-request-form-template\/#webpage"},"articleSection":"Customer Service, Health & Wellness, Service Request, Basic, Elite, Plus, Pro"},{"@type":"BreadcrumbList","@id":"https:\/\/wpforms.com\/templates\/counseling-session-request-form-template\/#breadcrumblist","itemListElement":[{"@type":"ListItem","@id":"https:\/\/wpforms.com\/templates\/#listItem","position":1,"name":"Home","item":"https:\/\/wpforms.com\/templates\/","nextItem":"https:\/\/wpforms.com\/templates\/counseling-session-request-form-template\/#listItem"},{"@type":"ListItem","@id":"https:\/\/wpforms.com\/templates\/counseling-session-request-form-template\/#listItem","position":2,"name":"Counseling Session Request Form Template","previousItem":"https:\/\/wpforms.com\/templates\/#listItem"}]},{"@type":"FAQPage","@id":"https:\/\/wpforms.com\/templates\/counseling-session-request-form-template\/#faq","url":"https:\/\/wpforms.com\/templates\/counseling-session-request-form-template\/","mainEntity":[{"@type":"Question","name":"How do I use WPForms form templates?","acceptedAnswer":{"@type":"Answer","text":"Our form templates are super easy to use. 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class="aioseo-breadcrumb-separator">›</span><span class="aioseo-breadcrumb"> Counseling Session Request Form Template </span></div> <header class="entry-header no-description"> <h1 class="entry-title title"> Counseling Session Request Form Template </h1> </header> <a href="https://wpforms.com/pricing/" class="button button-large" data-vars-ga-category="Templates Single" data-vars-ga-action="click" data-vars-ga-label="Use This Template (Bottom)">Use This Template</a> </div> </div> <div class="container single-container"> <div id="primary" class="site-content"> <main id="main" class="site-main" role="main"> <article class="post-23940 post type-post status-publish format-standard hentry category-customer-service category-health-wellness category-service-request-forms license-basic license-elite license-plus license-pro"> <div class="entry-content"> <div class="content-wpform-shortcode"> <div> <div class="wpforms-container wpforms-container-full form-template-disabled wpforms-container-save-resume wpforms-render-modern" id="wpforms-23939"><form id="wpforms-form-23939" class="wpforms-validate wpforms-form wpforms-ajax-form" data-formid="23939" method="post" enctype="multipart/form-data" action="/templates/counseling-session-request-form-template/" data-token="25f200a732e0747ab1fdeec0f0ffb63f" data-token-time="1732875372"><noscript class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript><div class="wpforms-hidden" id="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</div><div class="wpforms-field-container"><div id="wpforms-23939-field_1-container" class="wpforms-field wpforms-field-name" data-field-id="1"><fieldset><legend class="wpforms-field-label">Name <span class="wpforms-required-label" aria-hidden="true">*</span></legend><div class="wpforms-field-row wpforms-field-medium"><div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-23939-field_1" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][1][first]" aria-errormessage="wpforms-23939-field_1-error" required><label for="wpforms-23939-field_1" class="wpforms-field-sublabel after">First</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-23939-field_1-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][1][last]" aria-errormessage="wpforms-23939-field_1-last-error" required><label for="wpforms-23939-field_1-last" class="wpforms-field-sublabel after">Last</label></div></div></fieldset></div><div id="wpforms-23939-field_4-container" class="wpforms-field wpforms-field-layout" data-field-id="4"><div class="wpforms-field-layout-rows wpforms-field-large"><div class="wpforms-layout-row"><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-23939-field_2-container" class="wpforms-field wpforms-field-email" data-field-id="2"><label class="wpforms-field-label" for="wpforms-23939-field_2">Email Address <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="email" id="wpforms-23939-field_2" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][2]" spellcheck="false" aria-errormessage="wpforms-23939-field_2-error" required></div></div><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-23939-field_5-container" class="wpforms-field wpforms-field-phone" data-field-id="5"><label class="wpforms-field-label" for="wpforms-23939-field_5">Phone Number <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="tel" id="wpforms-23939-field_5" class="wpforms-field-medium wpforms-field-required wpforms-smart-phone-field" data-rule-smart-phone-field="true" name="wpforms[fields][5]" aria-label="Phone Number" aria-errormessage="wpforms-23939-field_5-error" required></div></div></div><div class="wpforms-layout-row"><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-23939-field_13-container" class="wpforms-field wpforms-field-select wpforms-field-select-style-classic" data-field-id="13"><label class="wpforms-field-label" for="wpforms-23939-field_13">Previous Counseling Experience <span class="wpforms-required-label" aria-hidden="true">*</span></label><select id="wpforms-23939-field_13" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][13]" required="required"><option value="Yes" >Yes</option><option value="No" >No</option></select></div></div><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-23939-field_8-container" class="wpforms-field wpforms-field-select wpforms-field-select-style-classic" data-field-id="8"><label class="wpforms-field-label" for="wpforms-23939-field_8">Preferred Session Format <span class="wpforms-required-label" aria-hidden="true">*</span></label><select id="wpforms-23939-field_8" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][8]" required="required"><option value="In-Person" >In-Person</option><option value="Virtual" >Virtual</option><option value="Phone" >Phone</option></select></div></div></div><div class="wpforms-layout-row"><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-23939-field_6-container" class="wpforms-field wpforms-field-date-time" data-field-id="6"><label class="wpforms-field-label" for="wpforms-23939-field_6">Date of Birth <span class="wpforms-required-label" aria-hidden="true">*</span></label><div class="wpforms-datepicker-wrap"><input type="text" id="wpforms-23939-field_6" class="wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium" data-date-format="m/d/Y" data-disable-past-dates="0" data-input="true" name="wpforms[fields][6][date]" aria-errormessage="wpforms-23939-field_6-error" required><a title="Clear Date" data-clear class="wpforms-datepicker-clear" style="display:none;"></a></div></div></div><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-23939-field_7-container" class="wpforms-field wpforms-field-text" data-field-id="7"><label class="wpforms-field-label" for="wpforms-23939-field_7">Preferred Pronouns</label><input type="text" id="wpforms-23939-field_7" class="wpforms-field-medium" name="wpforms[fields][7]" aria-errormessage="wpforms-23939-field_7-error" ></div></div></div><div class="wpforms-layout-row"><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-23939-field_16-container" class="wpforms-field wpforms-field-name" data-field-id="16"><label class="wpforms-field-label" for="wpforms-23939-field_16">Emergency Contact <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-23939-field_16" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][16]" aria-errormessage="wpforms-23939-field_16-error" required></div></div><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-23939-field_17-container" class="wpforms-field wpforms-field-phone" data-field-id="17"><label class="wpforms-field-label" for="wpforms-23939-field_17">Emergency Contact Number <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="tel" id="wpforms-23939-field_17" class="wpforms-field-medium wpforms-field-required wpforms-smart-phone-field" data-rule-smart-phone-field="true" name="wpforms[fields][17]" aria-label="Emergency Contact Number" aria-errormessage="wpforms-23939-field_17-error" required></div></div></div></div></div><div id="wpforms-23939-field_3-container" class="wpforms-field wpforms-field-textarea" data-field-id="3"><label class="wpforms-field-label" for="wpforms-23939-field_3">Reason for Seeking Counseling <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-23939-field_3" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][3]" aria-errormessage="wpforms-23939-field_3-error" required></textarea></div><div id="wpforms-23939-field_14-container" class="wpforms-field wpforms-field-textarea" data-field-id="14"><label class="wpforms-field-label" for="wpforms-23939-field_14">Specific Goals for Counseling <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-23939-field_14" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][14]" aria-errormessage="wpforms-23939-field_14-error" required></textarea></div> <div id="wpforms-23939-field_10-container" class="wpforms-field wpforms-field-text" data-field-type="text" data-field-id="10" > <label class="wpforms-field-label" for="wpforms-23939-field_10" >Phone Concerns Emergency</label> <input type="text" id="wpforms-23939-field_10" class="wpforms-field-medium" name="wpforms[fields][10]" > </div> <div id="wpforms-23939-field_15-container" class="wpforms-field wpforms-field-textarea" data-field-id="15"><label class="wpforms-field-label" for="wpforms-23939-field_15">Current Mental Health Concerns <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-23939-field_15" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][15]" aria-errormessage="wpforms-23939-field_15-error" required></textarea></div><div id="wpforms-23939-field_9-container" class="wpforms-field wpforms-field-repeater wpforms-field-repeater-display-blocks" data-rows-min="1" data-rows-max="10" data-clone-num="2" data-field-id="9"><input type="hidden" class="wpforms-field-repeater-clone-list" name="wpforms[fields][9][clone_list]" value="[]"><script type="text/html" class="tmpl-wpforms-field-repeater-template-9-23939"><div id="wpforms-23939-repeater-field_9-clone_{CLONE}" class="wpforms-field-repeater-clone-wrap" data-clone="{CLONE}"> <div 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document.currentScript?.remove(); } )(); </script></div><div class="wpforms-submit-container" ><input type="hidden" name="wpforms[id]" value="23939"><input type="hidden" name="page_title" value="Counseling Session Request Form Template"><input type="hidden" name="page_url" value="https://wpforms.com/templates/counseling-session-request-form-template/"><input type="hidden" name="page_id" value="23940"><input type="hidden" name="wpforms[post_id]" value="23940"><button type="submit" name="wpforms[submit]" id="wpforms-submit-23939" class="wpforms-submit" data-alt-text="Sending..." data-submit-text="Submit" aria-live="assertive" value="wpforms-submit">Submit</button><img src="https://wpforms.com/templates/wp-content/plugins/wpforms/assets/images/submit-spin.svg" class="wpforms-submit-spinner" style="display: none;" width="26" height="26" alt="Loading"></div></form></div>  <div class="block-required-plan block"> <div class="block-container"> <a href="https://wpforms.com/pricing/" class="plan-notice-box"> <div class="plan-badge-holder"> <span class="plan-badge">basic</span> </div> <span>This template includes features available in WPForms Basic. <span class="plan-compare">Compare Plans</span></span> </a> </div> </div> </div> </div> <div class="single-template-content"> <p>Mental health care is a critical component of personal well-being, and simplifying the process of seeking counseling can make a significant difference. The Counseling Session Request Form template is designed to do just that—remove barriers to access, create clarity, and support individuals in finding the help they need.</p> <h3>Navigating the Counseling Session Request Form Template</h3> <p>Let’s explore how this form template can benefit you and your clients:</p> <ul> <li><strong>Personalized Contact Information</strong>: The form begins by capturing basic details such as the individual’s name, email address, and phone number, ensuring the counselor can easily reach out to initiate contact and set up the session.</li> <li><strong>Insight Into Counseling History</strong>: A key feature of this form is the inclusion of the “Previous Counseling Experience” section, which allows users to indicate whether they have prior experience. This helps counselors understand whether the client may need an introductory session or already have a foundation in therapy.</li> <li><strong>Session Flexibility</strong>: Offering flexibility, the form asks the client to select their preferred session format, with options for in-person, virtual, or hybrid formats. This feature caters to diverse client needs and ensures sessions are accessible regardless of geographic or logistical limitations.</li> <li><strong>Inclusive and Secure Details</strong>: The addition of fields like “Preferred Pronouns” and “Date of Birth” reflects the form’s inclusive approach to client identity and ensures a personalized experience. Emergency contact information is also requested for safety and security during sessions.</li> <li><strong>Targeted Counseling Goals</strong>: Clients are asked to provide the “Reason for Seeking Counseling” and outline “Specific Goals for Counseling.” This helps counselors prepare effectively for the first session, ensuring that they understand the client’s main concerns and desired outcomes from the outset.</li> <li><strong>Scheduling Convenience</strong>: To accommodate busy schedules, clients can specify the days and times they are available for counseling. With the option to add multiple availability slots, this feature simplifies scheduling and makes booking sessions more efficient.</li> </ul> <p>Incorporating the Counseling Session Request Form template into your website will not only streamline the process for clients but also allow counselors to gain a comprehensive understanding of their needs from the very first point of contact. Get the template by signing up with WPForms today.</p> </div> </div> </article> </main> </div> </div> <div class="container wpf-pro-cta"> <a href="https://wpforms.com/pricing/" class="button button-large" data-vars-ga-category="Templates Single" data-vars-ga-action="click" data-vars-ga-label="Get WPForms Pro (Bottom)">Get WPForms Pro</a> </div> <div class="related-templates-wrap"> <h2 class="title">Looking for something else?</h2> <p>Here are some other <a href="https://wpforms.com/templates/category/customer-service">Customer Service form templates</a></p> <div class="related-templates-grid templates-list"> <div class="template-demo-block "> <div class="thumb-template"> <a href="https://wpforms.com/templates/product-sample-request-form-template/"><img src="https://wpforms.com/templates/wp-content/uploads/templates/thumb/adad8a23a09549b2a55da6ca6ea2f9ff.jpg" alt="Product Sample Request Form Template"></a> </div> <div class="content"> <header class="entry-header"> <h3 title="Product 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