Get Confidential New Client Intake Form - The

Completing the Confidential New Client Intake Form is an important step in your journey towards personal growth and effective support. This guide will walk you through each section of the form to ensure a smooth and accurate submission.

Follow the steps to successfully fill out the form online.

1. Press the ‘Get Form’ button to access the Confidential New Client Intake Form online.
2. Begin by entering your name at the top of the form. This will help identify your submission.
3. Fill in today's date followed by your date of birth. Note that the gender field offers options and you can select as appropriate.
4. Provide your address, including city, state, and zip code. This information is essential for identification purposes.
5. Input your contact information such as daytime and nighttime phone numbers, along with your email address.
6. Indicate your marital status and if applicable, provide details about any children.
7. Fill in the emergency contact section, including their name, relationship to you, and a phone number to reach them.
8. You will be asked to share your three favorite colors and places, as well as any fears or phobias. Answer these questions honestly to provide insight into your personality.
9. Indicate whether you have experienced an anxiety attack and describe the circumstances if applicable.
10. Disclose any compulsive behaviors or unhealthy habits. You can select whether you use substances such as alcohol, recreational drugs, or tobacco.
11. List any medications you are currently taking to inform your practitioner.
12. Outline your three most important life goals and favorite hobbies or pastimes to provide context for your sessions.
13. Mark any relevant issues that you may be experiencing, such as sleeplessness, anxiety, or financial stress.
14. Indicate whether you are currently receiving care from a doctor or mental health professional.
15. Provide personal reflections about your feelings and motivations. Answer the questions about your happiest moments, feelings of guilt, and anger.
16. Review the consent section carefully, ensuring you understand the terms and implications of participating in sessions. Sign and date the form.
17. Once all sections are completed, save your changes. You can choose to download, print, or share the form via email.

Complete your Confidential New Client Intake Form online today to start your journey!