Follow the steps to complete your intake form smoothly.

1. Click ‘Get Form’ button to access the Listening Ears Counseling form and open it in your chosen editor.
2. Begin with the demographic information section. Fill in your name, date of birth, age, and sex by selecting the appropriate option. Include your social security number and current marital status as indicated.
3. Provide your address, city, state, and zip code. Include your home, work, and cell phone numbers in the respective fields.
4. If you are a minor or representing someone who is, also complete the parent/guardian information section. Enter their marital status and names as required.
5. In the employment information section, indicate the current occupation and employer's details of the parent or guardian, if applicable.
6. Proceed to the education section to document the highest level of education completed, along with any special training and the name of the school.
7. Fill out the family information section by providing the spouse/partner’s name and listing your children. Include details about other significant family members and describe their relationship to you.
8. For counseling history, detail any prior counseling experiences, listing therapists or programs, major issues, and relevant dates.
9. In the medical history section, list any pertinent conditions, treatments, or surgeries. Note if you are currently under medical treatment and provide details of any medications you are taking.
10. Describe your present issues and goals, noting the reasons for seeking counseling, issues faced, and symptoms experienced.
11. Review the list of possible symptoms and check any that apply to your current situation.
12. Indicate how distressing your chosen problems are by marking your level of distress on the provided scale.
13. Conclude by detailing any suicidal thoughts or past attempts if applicable, and express what you hope to achieve from the counseling process.
14. Finally, sign and date the form. Make sure to review all sections for completeness.
15. Once your form is completed, utilize the available options to save changes, download a copy, print the form, or share it as needed.

Complete your Listening Ears Counseling form online today for a seamless counseling experience.