Get Child Intake Form - Therapy By Kristy Kirby

The Child Intake Form is an essential document that helps gather biographical information about your child, aiding in the therapeutic process. This guide provides clear instructions for filling out the form online to ensure a comprehensive representation of your child's background.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin with the identifying information section. Fill in the date, your child's name, date of birth, age, and the name of the person completing the form, along with their relationship to the child.
3. Continue by providing the child's address, phone numbers, current school, grade, physician's name, and date of the last exam. Make sure to list any medications the child is currently taking.
4. In the section regarding the reason for seeking services, provide specific details about the concerns you have for your child and describe how long these issues have been present.
5. List any previous counseling services your child has received along with the dates and reasoning for those services.
6. Describe your child's strengths, skills, and any supports they have, as this information can be vital in the counseling process.
7. In the family history section, document information regarding the child's parents or guardians, including names, birth dates, addresses, cell phone numbers, occupations, and highest level of education.
8. Indicate who has legal guardianship of the child and answer questions regarding any family history of substance use.
9. List all significant relationships in your child's life, along with details on whether they live with the child.
10. Indicate any significant experiences the child has faced, such as adoption, violence, or illness, and include relevant dates.
11. Provide details of your child's school history, including their current school, grade, and any feedback received from teachers regarding your child's behavior or performance.
12. Document any medical history, including information on allergies, past hospitalizations, or significant injuries. Include prenatal factors if applicable.
13. In the developmental history section, provide information about your child's early years and any notable behaviors or challenges during infancy.
14. Lastly, note any additional information that may be important for the therapist to know about your child or family situation.
15. Once you have filled out all sections, ensure that you save your changes and consider downloading, printing, or sharing the completed form as needed.

Complete the Child Intake Form online today to support your child's therapeutic journey.