Get Intake Form - Langley Cdc

Completing the Intake Form - Langley CDC online is a straightforward process that helps gather essential information about your child and their needs. This guide will walk you through each section of the form, ensuring you have the support needed to complete it accurately.

Follow the steps to successfully fill out the Intake Form.

1. Press the ‘Get Form’ button to access the Intake Form and open it in an editable format.
2. In the 'Name of Child' field, enter the full name of the child who is the subject of the intake.
3. Next, provide the 'Client ID#' for office use only. Leave this field blank if you do not have an ID.
4. Fill in the 'Birth Date' field using the format month/day/year.
5. Indicate the child's 'Gender' by selecting either Male or Female.
6. In the 'Ethnicity' section, complete the information regarding Aboriginal Heritage as applicable.
7. Input the 'Care Card Number' if applicable. This information is necessary for health services.
8. Under 'Birth Information,' include details like the hospital of birth, referral source, birth weight, and gestational age.
9. Provide the 'Date of Referral' in the format m/d/y and state the reason for the referral or diagnosis.
10. In the 'Child’s Residential Information' section, specify the legal guardian(s) and provide names, address, phone number, email address, and postal code.
11. List any siblings by including their names and birth dates as requested.
12. Fill out the 'Agencies Involved' section by entering addresses and contact information for relevant agencies.
13. Include any 'Additional Information' regarding cultural or religious observances that may be important.
14. Sign in the 'Parent/Guardian Signature' field to confirm the information is accurate.
15. Indicate whether the parent/guardian is aware of the referral by selecting either Yes or No.
16. Finally, review all entered information for accuracy, then save changes, download, print, or share the completed form as needed.

Take the first step in supporting your child's development by completing the Intake Form online today.