Get Adult Shelter Client Intake Form - Jrsa

Completing the Adult Shelter Client Intake Form - Jrsa is an important first step in seeking assistance and support. This guide offers a clear and structured approach to filling out the form online, ensuring that you provide all necessary information accurately and confidently.

Follow the steps to complete the intake form effectively.

1. Press the ‘Get Form’ button to access the Adult Shelter Client Intake Form - Jrsa and open it in your preferred editor.
2. Begin by entering the agency or shelter's name in the designated field at the top of the form.
3. Fill in your Social Security number (SSN) in the next section to help with identification.
4. Provide your first name, middle initial, and last name in the appropriate fields.
5. Next, enter your current address, including any apartment number, city, state, and county.
6. Complete the identification section by providing the ID number required.
7. Move to the medical and income tab. Indicate whether you have had a child’s medical release and if you are pregnant. Also, select appropriate options related to disability and provide information about your doctor and insurance.
8. Document any medications you take and any allergies you may have, as well as those of any children in your care.
9. In the personal information section, enter your intake date, time, race, ethnicity, birth date, age, phone numbers, email, and emergency contact details.
10. Specify your automobile details if applicable, including the license plate and state.
11. Fill in the client’s income section by providing sources and total amounts, and answer whether you are below the poverty level.
12. In the abuser information tab, provide required details regarding your abuser, including their name, address, sex, race, and other pertinent information.
13. Next, enter information about your dependents, previous shelter history, education, referral sources, and your current housing situation.
14. Indicate your relationship with the abuser and provide context about your time together.
15. In the mental health section, answer questions regarding your mental health treatment history, current medications, and any behavioral observations.
16. After you have filled out all the required fields across the different tabs, review your entries for accuracy.
17. Finally, save your changes, and utilize the options to download, print, or share the completed form as necessary.

Get started now by filling out the Adult Shelter Client Intake Form - Jrsa online.