Get Adult Neurological Supplemental Intake Form (pdf) - Wwu

Completing the Adult Neurological Supplemental Intake Form is an essential step in accessing the appropriate services for your neurological needs. This guide provides clear instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your general information in the designated fields. Fill in your name and date of birth. This information helps establish your identity within the system.
3. Consider the question about your work status at the time of your illness. Specify if you intend to return to work and what assistance you seek from the clinic.
4. Reflect on your past activities. In the designated field, indicate the hobbies or groups you were involved with before the onset of your condition.
5. Next, describe your current involvement. What activities, hobbies, or groups engage your time and energy now? Complete this information in the provided section.
6. Provide a detailed description of a typical day. Include your wake time, meal times, rest periods, and any work-related activities, so the clinic can understand your routine.
7. Express your biggest frustrations or concerns regarding your reasons for seeking services. This insight is critical for the clinic to tailor their support.
8. In the section labeled 'Person Completing Form,' include your details, along with your relationship to the client to clarify your role.
9. Finally, sign and date the form to validate the information you've provided. Ensure that all required fields are completed before submission.
10. Once you have filled out all necessary sections, download or save the completed form. You can choose to print it or share it as needed.

Complete your Adult Neurological Supplemental Intake Form online today to take the first step towards your care.