🧬 Free Clinical Tool

Genogram Intake Forms & Builder

Capture a complete, three-generation clinical family assessment. Choose your intake template, fill in the data, then let AI build your genogram in one click.

100% Local — No Server Storage HIPAA-Friendly 4 Clinical Templates Print-to-PDF Ready
Pro

Ready to auto-build this genogram in seconds? Paste your intake narrative into Genosm's AI engine — genogram, SOAP notes & treatment plan in one click.

✨ Try Genosm Pro Free →

Step 1 — Choose Your Clinical Template

🌀
Bowen Family Systems
Triangles, cutoffs, differentiation & multigenerational transmission
🏗️
Structural / Psychotherapy
Minuchin boundaries, subsystems, life cycle & acculturation
🔬
Genetic Counseling
NSGC-standard pedigree with pregnancy outcomes & zygosity
🤝
Social Work / Eco-systems
Ann Hartman ecomap with mandates, resource flow & strengths
CORE Universal Core Demographics

A. Index Person (Proband)

B. Current Household Composition

C. Parents / Family of Origin

D. Sibling Subsystem (Birth Order)

E. Partnerships & Children (Family of Procreation)

GEN II Grandparents & Second Generation
BOWEN Bowen Family Systems Assessment

AI-Ready Narrative

[ Fill in the form to generate your AI-ready clinical narrative ]

Copies current state — blank or filled. Auto-updates as you type.

How to auto-build your Genogram

1

Click Copy Intake Form above to copy your clinical intake summary (works on blank forms too).

2

Open the Genosm App and navigate to the AI Assistant tab in the right sidebar.

3

Paste the narrative and click Generate. Your full 3-generation genogram renders instantly.

4

From there, auto-generate SOAP notes, a Treatment Plan, and customise or export to PDF/PNG/SVG.

🔒

Protect Patient Privacy — Enable PII Shield

Before clicking Generate in the app, switch the PII Shield toggle ON in the AI sidebar. This automatically redacts real names (e.g. replacing "Jane Smith" with "Mother") before sending any data to the AI model — keeping patient records fully confidential while still generating a clinically accurate genogram.

✨ Open Genosm App to Build Genogram
⚡ Genosm Pro

Turn This Intake Into a Genogram in One Click

Copy your intake form narrative, open the Genosm App, paste into the AI Assistant, and hit Generate. Your full three-generation genogram renders instantly — complete with relationship lines, medical markers, and Bowenian notation. Then auto-generate SOAP notes, a full treatment plan, and export to PDF, PNG, or SVG.

  • ✓ AI Genogram Builder
  • ✓ SOAP Notes Generator
  • ✓ Treatment Plan Maker
  • ✓ PII Shield
  • ✓ Export PDF / PNG / SVG
  • ✓ Ecomap + Genogram Combo
✨ Try Genosm Pro Free View Pricing & Plans

What is a Genogram Intake Form?

A genogram intake form is a structured clinical assessment tool that collects multi-generational family information across three or more generations. Unlike a standard medical family history questionnaire, a genogram intake form is specifically designed to capture both structural data (who is in the family, how they are related) and relational or clinical data (emotional dynamics, medical conditions, psychological patterns, and social ecology).

The result is a rich, layered dataset that can be visually rendered as a clinical genogram — a standardized family diagram developed by Monica McGoldrick and Randy Gerson — which allows therapists, genetic counselors, nurses, and social workers to identify patterns at a glance that would take hours to extract from narrative notes alone.

This tool provides four specialized intake templates corresponding to the most common clinical disciplines that use genograms: Bowen Family Systems Therapy, Structural Family Therapy, Genetic Counseling (NSGC pedigree standard), and Social Work Eco-systems assessment.

The Four Clinical Intake Templates Explained

🌀 Template 1: Bowen Family Systems Intake

Developed by psychiatrist Murray Bowen, Bowen Family Systems Theory treats the family as an emotional unit governed by eight interrelated concepts: Differentiation of Self, Triangles, Nuclear Family Emotional System, Family Projection Process, Multigenerational Transmission Process, Emotional Cutoff, Sibling Position, and Societal Emotional Process.

This intake form is structured to collect data across all eight dimensions. It emphasizes identifying triangulation patterns (three-person systems that manage dyadic anxiety), functional sibling positions (e.g., the responsible oldest, the rebellious youngest), nodal events (major life shockwaves such as sudden deaths, bankruptcy, or migration), and evidence of multigenerational transmission of behaviors such as addiction, perfectionism, or chronic anxiety.

🏗️ Template 2: Structural / Psychotherapy Intake

Salvador Minuchin's Structural Family Therapy (SFT) maps family health through the quality of subsystem boundaries and family hierarchy. Where Bowen is interested in the vertical (intergenerational) transmission of anxiety, Minuchin is interested in the horizontal (current-generation) structure of power and proximity.

This template captures the Spousal, Parental, and Sibling subsystems separately, assesses boundary types (rigid/disengaged, clear/healthy, or diffuse/enmeshed), identifies coalitions and cross-generational alliances, and captures the family's current life cycle stage — a critical variable since the demands on family structure differ dramatically between, say, a family with young children versus one launching adult children.

🔬 Template 3: Genetic Counseling / Medical Pedigree Intake

Medical genograms (pedigrees) follow the National Society of Genetic Counselors (NSGC) nomenclature standard. They require specific clinical data points that general therapy genograms often omit: precise age of onset for each condition (e.g., "breast cancer at age 38" is clinically far more significant than simply "breast cancer"), twin zygosity (identical vs. fraternal), pregnancy outcomes including spontaneous and induced abortions, and consanguinity indicators.

The output of this template generates a structured pedigree-ready narrative that can be used to identify inheritance patterns, calculate recurrence risks, and guide referral decisions for genetic testing.

🤝 Template 4: Social Work / Eco-systems (Ecomap) Intake

Developed by Ann Hartman in the 1970s, the ecomap places the family at the center of its social ecology — mapping relationships with schools, employers, healthcare providers, religious institutions, neighbors, legal systems, and community organizations. Unlike the genogram (which looks backward at history), the ecomap is a present-tense snapshot of the family's current social world.

This intake captures institutional mandates (CPS involvement, probation, family court, special education IEPs), assesses whether each external system is a source of energy or a drain (resource flow direction), identifies community strengths, and documents cultural and spiritual resources. It is particularly critical for child welfare, case management, and community-based practice settings.

How the AI Narrative Generation Works

As you complete the intake form, this tool generates a structured, hierarchical Markdown narrative in the output panel on the right. The format is specifically optimized for Genosm's AI engine to parse with maximum accuracy — using labeled sections, explicit relationship directives, and clinical terminology that aligns with McGoldrick genogram conventions.

When you paste this narrative into the Genosm App's AI Assistant tab and click Generate, the AI engine reads the structured data and:

  • → Creates family member nodes with correct gender symbols and demographic labels
  • → Draws relationship lines (marriage, divorce, separation, cohabitation)
  • → Applies emotional relationship indicators (fused, hostile, distant, cutoff) from Bowenian data
  • → Attaches clinical condition markers and medical annotations to nodes
  • → Positions three generations on the canvas in standard McGoldrick layout

The resulting diagram can then be fine-tuned, annotated, exported to PDF/PNG/SVG, or used as the basis for generating SOAP notes and treatment plans — all within the Genosm workspace.

🔒 Privacy, HIPAA & PII Shield Guidance

This intake builder is 100% local-first. All data you enter is stored only in your browser's localStorage and is never transmitted to Genosm servers. No cloud sync, no analytics tracking of patient data, no third-party access.

However, when you use the "Copy Narrative → Open Genosm App → Generate" workflow, the narrative text is sent to an AI language model to generate the diagram. To protect patient confidentiality in this step:

  • 1. Use pseudonyms or initials in all name fields (e.g., "J.S." or "Mother" instead of full legal names).
  • 2. Enable the PII Shield toggle in the Genosm App's AI sidebar. This automatically redacts identifiable information before the data is transmitted to the AI model.
  • 3. Use year of birth rather than exact birth dates where possible.
  • 4. Regularly export your data as JSON and store it in your encrypted practice management system.

Frequently Asked Questions

What clinical disciplines use genogram intake forms?

Family therapists (MFTs, LMFTs), Licensed Clinical Social Workers (LCSWs), licensed counselors (LPCs), psychologists, genetic counselors, medical social workers, nurses, occupational therapists, and family medicine physicians all use genogram assessments as part of comprehensive intake.

How many generations does the form capture?

The builder captures a minimum of three generations (grandparents, parents, index generation) which is the clinical standard for identifying intergenerational patterns. The form can be extended by adding additional family members manually in the sibling and grandparent sections.

Can I save and return to my intake form?

Your form data is auto-saved to your browser's localStorage every time you type. If you close and reopen the page, your data will still be there. Export the JSON backup (via Print or Copy) before clearing your browser cache.

Is this a replacement for clinical training?

No. This tool is a documentation and assessment aid. All clinical decisions, interpretations, diagnoses, and interventions must be made by licensed professionals. The intake form is a scaffold, not a substitute for clinical judgment.