Get Loralie Grigas Intake Form New 8-2013doc

This guide aims to provide a clear and supportive framework for users looking to complete the Loralie Grigas INTAKE FORM New 8-2013doc online. Whether you are familiar with digital forms or not, these step-by-step instructions will help you fill out the form efficiently.

Follow the steps to complete the intake form accurately.

1. Click the ‘Get Form’ button to acquire the intake form and open it in your preferred online editor.
2. Begin filling out the form by entering your full name in the specified fields: last name, first name, and middle initial.
3. Enter your complete address, including street, city, state, zip code, and county in the designated sections.
4. Provide your contact information by filling in your home, work, and cell phone numbers. Indicate whether it is acceptable to leave messages at these numbers.
5. Specify your email address and indicate if you prefer to be contacted via email.
6. Record the name of the person or organization that referred you.
7. Input your social security number and birthdate; specify your age and gender.
8. Fill in the emergency contact information, including their name, relationship to you, phone number, and address.
9. Indicate if you have previously received psychiatric services or therapy and provide the dates and names of your providers if applicable.
10. List your primary care doctor’s name, address, and phone number.
11. Document any current medications you are taking, including their names and dosages.
12. Provide your household income if required for fee determination, and select your marital status from the provided options.
13. Select your legal status from the options given and specify the referral source.
14. Indicate any symptoms or issues you are experiencing and describe your reasons for seeking services in the designated area.
15. Read the office policies and consent for treatment carefully, and ensure you understand all terms before signing the form.
16. Once you have filled out all applicable fields, save your changes, and choose to download, print, or share the completed form.

Complete your Loralie Grigas INTAKE FORM New 8-2013doc online today to ensure timely processing of your information.