Get Ed Fitzpatrick Sequim

Filling out the Ed Fitzpatrick Sequim intake form is a crucial step in beginning your counseling journey. This guide will provide you with clear and supportive instructions on how to complete the form accurately and confidently.

Follow the steps to successfully complete the intake form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your full name in the designated field. If you are under 18 years old, please include the name of your parent or guardian.
3. Fill in your birth date in the format MM/DD/YYYY and provide your age in the corresponding space.
4. Select your gender by checking the appropriate box for 'Male' or 'Female'.
5. Indicate your marital status by selecting one option from the provided choices, including 'Never Married', 'Domestic Partner', 'Married', 'Separated', 'Divorced', or 'Widowed'.
6. If applicable, list any children and their ages in the designated area.
7. Input your residential address in the address field.
8. Enter your home phone number in the specified format. Indicate if you would like a message to be left if unable to reach you.
9. Provide your cell or other phone number and specify if you would like a message left if you are not available.
10. Fill in your email address, and indicate whether you would like to receive emails.
11. Note that email communications are not considered confidential. If you have been referred by someone, please include their name here.
12. Finally, indicate whether you have previously received mental health services by selecting 'Yes' or 'No'. If 'Yes', provide the name of your previous therapist or practitioner.
13. Once you have completed the form, save your changes, and follow the instructions provided for downloading, printing, or sharing.

Start filling out your Ed Fitzpatrick Sequim intake form online today!