Get Client Intake Form-06-16-cc.doc - Conexuscounselling

Filling out the Client Intake Form is an important step in your counseling journey. This guide will walk you through each section of the form to ensure that you provide all the necessary information accurately and confidently.

Follow the steps to complete the Client Intake Form effectively.

1. Press the ‘Get Form’ button to obtain the Client Intake Form and open it in your preferred document editor.
2. Begin by providing your personal information. Fill in your full name, date of birth (DOB), age, address, and postal code. Ensure all contact numbers are accurate, and indicate if you are comfortable receiving messages on those numbers.
3. Next, provide your email address in the designated field, noting that this is optional but helps with communication.
4. Complete the emergency contact section with the name and phone number of an individual you trust.
5. Record your occupation or profession, including how long you have been in that role. If you are currently unemployed, briefly describe your situation.
6. Indicate your highest level of education from the provided options and share your religious upbringing and current affiliation.
7. Describe your marital status, the number of marriages, and provide your partner’s name (if applicable). If living with a partner, indicate the length of that relationship and their education level.
8. Fill out the section regarding your children and dependents, listing their names, ages, and relationships to you.
9. In the family information section, answer questions about where you were born, details of your siblings, and the status of your parents, including their professions and relationships with you.
10. In the general medical condition section, provide details about your primary physician, any medical conditions you may have, and hospitalization history.
11. Address your mental health history by describing any past diagnoses and indicating your experiences with suicidality, medication, and mental health treatment.
12. State the reason for seeking counseling, along with the specific issues you wish to address.
13. Once you have completed all sections, review your entries for accuracy. After verifying that all information is correct, you can save your changes, download, print, or share the completed form as needed.

Complete your Client Intake Form online today to begin your counseling journey.