Get A&m Christian Counseling Center Clinical Intake Form

The A&M Christian Counseling Center Clinical Intake Form is a crucial document for initiating your therapeutic journey. This guide provides clear and supportive instructions on how to complete the form online, ensuring you understand each section and can provide the necessary information.

Follow the steps to effectively complete the intake form online.

1. Press the ‘Get Form’ button to access the form and open it in your editing platform.
2. Begin by filling in the date at the top of the form. You will also need to provide your full name, date of birth, and social security number. These details help identify you and ensure your information is kept confidential.
3. Next, indicate your age and gender. Select 'Male' or 'Female' as appropriate. Additionally, enter your current occupation.
4. Provide your partner’s name if applicable and enter your complete address including city, state, and zip code.
5. Fill in your phone numbers for home, work, and cell contact, and specify if you allow messages to be left at any number. Include your email address for communication purposes.
6. Indicate your current employment status and provide your gross yearly household income by selecting the appropriate income bracket.
7. Select your current relationship status from the options given, and provide information about your partner if applicable, including how long you have been together.
8. When discussing your family, indicate whether you have children and fill in the required details for each child, including age and living situation.
9. For family history, provide information about your parents and siblings, including their ages and any deceased family members.
10. Discuss your relationships with your parents in the designated sections and share any relevant family mental health history.
11. Fill out your educational background, specifying any degrees earned and the majors if applicable.
12. Describe your religious or spiritual background, including any affiliations, past or present.
13. Provide details of your medical history, including any significant health issues or recent medical examinations.
14. Outline your counseling history, including any previous experiences with therapy and current therapy status.
15. List any medications you are currently taking or have taken in the past, along with their dosages and any noted side effects.
16. Answer questions regarding alcohol and drug usage, including types, amounts, and frequencies.
17. Indicate your suicide risk history and provide details if applicable.
18. Document any history of abuse or trauma and details of your support system.
19. Clarify your presenting issues and describe what you hope to achieve through counseling.
20. Define your specific goals for therapy, including how you will recognize when therapy is no longer needed.
21. Indicate any areas of concern or stress by marking current or past issues.
22. Finally, provide referral information, emergency contacts, and any other necessary details indicated at the end of the form.
23. Once all sections are completed, ensure you save your changes. You may also choose to download, print, or share the form as needed.

Complete your intake form online today to begin your counseling journey.