Get 1 Wellspring Psychotherapy Center Adolescent Intake Form Child's ...

Completing the 1 Wellspring Psychotherapy Center Adolescent Intake Form online is an important step in ensuring your child's mental health needs are addressed. This guide will provide you with clear instructions and support as you navigate each section of the form.

Follow the steps to fill out the form accurately and efficiently.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Begin by entering the child's name, age, and date of birth in the designated fields.
3. Proceed to fill in the teen’s email and phone number for further communication.
4. List each sibling's name and age in the provided lines, ensuring all siblings are included.
5. Next, input the mother's name, address (including city, state, and zip code), marital status, phone numbers, email, occupation, and employment status.
6. Repeat the process for the father's information, ensuring accurate contact details and employment information.
7. If applicable, enter the step-parent's or guardian's information including name, address, marital status, phone numbers, email, occupation, and employment status.
8. In the 'History of Problem' section, describe any concerns regarding your child and how long they have existed.
9. Indicate any attempts made to resolve the difficulties and list any significant stressors your family has faced in recent years.
10. Check any symptoms your child is currently experiencing and provide details regarding their duration and severity.
11. In the 'Social Media/Electronics Use' area, state the average number of hours your child spends on video games, texting, social media, and watching TV.
12. Complete the section requesting other child information, including school, grade, academic performance, psychiatric history, medical problems, and current medications.
13. Provide information regarding family history, including custody arrangements if applicable, medical issues, and any relevant treatment or medication histories for family members.
14. Once you have filled out all the information, review the form for accuracy. After ensuring all fields are completed, you may save changes, download, print, or share the form as necessary.

Begin the process of completing the 1 Wellspring Psychotherapy Center Adolescent Intake Form online today.