Request an Appointment (Behavioral Health)
Use this secure form to let new and returning counseling clients request an appointment. It’s a great way to protect your clients’ information before they even become a client — because the personal information they share may be sensitive without them even knowing it. Place it on your website, publish your link in directories, or add it to your email signature.
Form Template Preview
Submit this form to see what a completed submission looks like inside Hushmail:
Quick facts about this form
Who it's for:
- Therapists
- Counselors
- Psychologists
- Psychiatrists
- Behavioral health practices
- Social work practices
Why use it:
- Protect client privacy with automatic encryption and HIPAA compliance from the very first interaction
- Show clients you take confidentiality seriously from the start
- Streamline intake by receiving appointment requests directly in your Hushmail inbox
- Let clients request an appointment 24/7 without needing to call
Where to use it:
- On your practice website (e.g., your contact page)
- In your Psychology Today profile
- In your email signature
- On your social media profiles
Pairs well with:
If your client skips a required field, the form will prompt them to fill it out. No more chasing after clients to fill out missing info.
Your client’s submission will live in Hushmail, where you can keep all submissions secure and organized in folders.
You can also download a PDF of the submission if you want to file a separate copy elsewhere, like your EHR.
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1.
You give us the form(s) you’re currently using in your practice.
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You get a dedicated Customer Care rep to oversee the service and answer questions.
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You end up with custom secure web forms that are easy for your clients to fill out.
