We assessed clinical intake paperwork (N = 128) from three similar, mid-sized Midwestern counties for cultural variable inclusion and response formats (i.e., checkbox, open-ended) via systematic content analysis. We found no patterns across intakes or geographic area in terms of which cultural variables counselors included on their intake paperwork, though we found consistency in terms of response type. To date, few researchers have examined counselor intake paperwork, specifically cultural variable inclusion, and theoretical recommendations are inconsistent. We suggest that asking about client cultural identities on intake paperwork is a vital first step in the counseling process, demonstrating openness, warmth, and unconditional positive regard as a foundation for the working alliance. We present pertinent literature and research findings and offer recommendations for counseling professionals to strengthen cultural identity inclusion in their intake paperwork.

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