Get Mercer Family Resource Center New Client Intake - Youth 2018-2025

Completing the Mercer Family Resource Center New Client Intake - Youth form is an important step in accessing support services for youth and their families. This guide provides clear, step-by-step instructions on how to fill out the online intake form efficiently and accurately.

Follow the steps to complete your online intake form.

1. Click ‘Get Form’ button to access the intake form in your preferred document editor.
2. Begin by filling out the 'General Information' section, including the client name, parent or guardian's name, previous client status, and date. Ensure all required fields are filled out accurately.
3. Provide the client’s mailing address, city, state, and zip code. Include contact numbers for both the parent and youth.
4. Indicate the youth's date of birth and age. You will also need to check the household income tier that applies based on your household's annual income.
5. Answer the question regarding the ability to leave voice mails and select the gender. Fill out the race and disability-related questions, if applicable.
6. Provide information about medical insurance, if applicable, and note how you found the Mercer Family Resource Center.
7. Complete the 'Emergency Contact Information & Authorization' section, which includes providing a contact's name, relationship, and phone numbers.
8. Review the sections regarding the authorization to release confidential information and sign where necessary. Each field needs initials or signatures where indicated.
9. Make sure to read and acknowledge the consent for services section, client confidentiality, client rights, and the no-show policy. Provide your printed name and signature.
10. Once you have completed all sections of the form, save your changes. You have options to download, print, or share the completed document as needed.

Start the process of filling out the Mercer Family Resource Center New Client Intake - Youth form online today!