Get Child Intake Form

Filling out the Child Intake Form online is an important step in beginning therapy for your child. This guide provides detailed instructions to help you navigate each section of the form with clarity and confidence.

Follow the steps to complete the Child Intake Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the designated online editor.
2. Begin entering the information for the parent or caregiver. Fill in the last and first name, and indicate your relationship to the child or adolescent.
3. Indicate whether you have legal authority to provide consent for treatment by checking the appropriate box for 'Yes' or 'No'.
4. Provide the child's or adolescent's name by entering their last and first name. Include their birth date in the specified format.
5. Select the gender of the child by checking either the 'Male' or 'Female' box.
6. Fill in the school name and the grade level that the child is currently attending. Specify if the child is currently attending school by checking 'Yes' or 'No'.
7. Enter the home address, including street number, city, state, and zip code.
8. Provide home and cell or other phone numbers. Indicate whether messages can be left on both numbers by checking 'Yes' or 'No'.
9. Input an email address and note that email correspondence is not considered confidential.
10. Respond to questions about significant stressful events, character strengths, areas for improvement, and therapy goals by providing thoughtful answers in the provided spaces.
11. Identify the referral source for the child by checking the appropriate box, or providing additional details if applicable.
12. Review the limits of confidentiality and cancellation policy sections to understand your rights and responsibilities.
13. Sign and date the form where indicated as both the client and, if applicable, a witness.
14. Once you have completed all sections, you can choose to save changes, download a copy, print the form, or share it as required.

Begin your online documentation process now and ensure your child's therapeutic journey starts smoothly.