Get Child Therapy Intake Form - Blake Psychology

Completing the Child Therapy Intake Form is a crucial step in ensuring your child's psychological needs are addressed. This guide provides step-by-step instructions to help you navigate the form efficiently and effectively.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the intake form and open it in your preferred editor.
2. Begin by providing your name, relation to the child, phone number, and email address in the designated fields at the top of the form.
3. Fill in the section for the other parent or legal guardian’s details, including their name, phone number, and email.
4. Enter your child's first and last name, age, birth date, ethnicity, religion, sex or gender, and home address in the appropriate fields.
5. In the academic information section, input the name of your child’s school, their grade or year, program, and typical grades.
6. Indicate how you found out about the clinic by checking the appropriate box or writing in other sources.
7. Describe the reasons for your child's visit and their emotional distress intensity using the provided scale.
8. Document your child’s psychiatric and medical history, including any diagnoses and medications.
9. Reflect on your child's mental health treatment history, noting any past hospitalizations or consultations.
10. Detail your child's current habits across various categories such as smoking, drinking, and exercise.
11. Evaluate your child’s relationships with family, friends, and others, providing your observations in the designated section.
12. Note any stressful life events your child may have experienced and describe their positive qualities and interests.
13. Finally, review any concerns about therapy, expected goals, and any additional information you'd like to share.
14. Once all sections are complete, save your changes, download, print, or share the completed form as needed.

Start filling out your Child Therapy Intake Form online today to take the first step towards supporting your child's mental health.