Get Returning Client Intake Form - Blake Psychology

Completing the Returning Client Intake Form is a crucial step for individuals re-opening their files at Blake Psychology. This guide provides a clear, step-by-step approach to ensure you fill out the form accurately and efficiently for your upcoming session.

Follow the steps to fill out the form correctly.

1. Use the 'Get Form' button to access the Returning Client Intake Form and open it for editing.
2. Begin by entering your personal information, including your first name, last name, and age. Ensure that all details are accurate to avoid any potential issues.
3. Provide your date of birth by filling in the day, month, and year sections. This information helps the clinic understand your background better.
4. Complete your home address, including the postal code. This detail is important for correspondence and potential emergencies.
5. Indicate who you currently live with. This may provide context for your therapy and support system.
6. Fill in your preferred contact numbers, including your cell, home, and work numbers. These will be essential for scheduling and updates.
7. Enter your email address to facilitate communication regarding appointments and other information.
8. Provide the name and phone number of an emergency contact. This is crucial for your safety and well-being.
9. If you are under 18 years of age, complete the sections for your parent or legal guardian, including their contact information.
10. Detail the reasons for your visit. Take your time to elaborate on the reasons that have brought you back to therapy.
11. List any significant changes in your life since your last visit, such as changes in job, relationships, or medications.
12. Rate your emotional distress on a scale from 1 (mild) to 10 (severe). This helps your therapist understand your current emotional state.
13. Reflect on how the issues affect your daily functioning, including work, school, and relationships. Provide a description of how manageable or disruptive these challenges are.
14. Once you have completed all sections, you can save your changes, download, print, or share the form as needed.

Complete your Returning Client Intake Form online for a seamless and supportive experience at Blake Psychology!