Get Background Information Form

Filling out the Background Information Form online is a straightforward process designed to collect important details efficiently. By following these instructions, you will ensure that all necessary information is accurately provided.

Follow the steps to complete the Background Information Form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated field at the top of the form. Ensure that you provide your full legal name for accurate processing.
3. In the ‘Date of Birth’ section, input your birth date in the specified format. Following this, fill in your age in the next available field.
4. Provide your Social Security Number (SSN) in the corresponding section. This is a crucial identifier, so make sure it is entered correctly.
5. Fill out your address in the appropriate fields, including your city, state, and zip code, to ensure accurate correspondence.
6. Input your home telephone number in the designated field. Indicate whether it is acceptable to leave a message by selecting ‘Y’ or ‘N’.
7. Complete the work telephone number section in the same manner, noting your preference for messages.
8. Enter your cellular phone number and indicate your message preference again.
9. Note the total years of school you have completed in the corresponding field.
10. In the ‘Occupation’ section, provide your current job title or description.
11. Next, fill in the name of your employer or school.
12. State your marital status in the designated field, followed by the length of your relationship if applicable.
13. If relevant, fill in your spouse's or partner's name and age.
14. If applicable, include your parent’s information, such as date of birth and SSN.
15. You will need to share the names and ages of your children in the appropriate section.
16. In case of an emergency, provide a contact name and telephone number.
17. Answer the question about previous counseling experiences, including the time frame and the counselor's name.
18. Indicate who referred you for counseling.
19. List your personal physician's name and the reasons for your visits.
20. Document any medical conditions you have in the provided space.
21. If you are currently taking any medications, please list them along with their dosages.
22. Outline the present problem as you perceive it in the final section.
23. Finally, provide your signature in the designated area along with the date to certify your form.
24. Once completed, save your changes, and you can download, print, or share the form as needed.

Complete your Background Information Form online today for a seamless submission experience.