Get Intake Assessment Example

Completing the Intake Assessment Example is an essential step in ensuring your child's needs are understood and addressed. This guide will provide you with clear, simple instructions to assist you in filling out the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Intake Assessment Example. This will open the form in an online editor where you can enter your information.
2. Begin with the Identifying Information section. Fill in your child's name, today's date, date of birth, age, grade, sex, race/ethnicity, and religious affiliation. Make sure all details are accurate.
3. Complete the section for the person(s) filling out the form. Provide your name and indicate who suggested contacting the psychologist.
4. Enter your child's custodian/guardian information along with their home address, city, state, zip code, home telephone number, and any alternative phone numbers.
5. Indicate whether it is okay to contact you or your child at home and if messages can be left, providing any special instructions as necessary.
6. Move on to the Mother's Information section. Provide the mother's name, date of birth, home phone number, address, race/ethnicity, religious affiliation, highest grade completed, and employment status. Check the appropriate marital/relationship status.
7. Input the same type of information for the father's section, including name, contact details, race/ethnicity, and employment status.
8. If applicable, fill out the step-parent's information using the same format as the mother and father sections.
9. In the Reason for Seeking Treatment section, succinctly describe the problems your child is experiencing, the reasons for seeking help now, and the goals you hope to achieve through treatment.
10. Detail the child's medical history and any previous therapy experiences. Provide information about any previous hospitalizations or emotional/behavioral problems.
11. Fill out the Family section, including any significant experiences related to parental separation, custody arrangements, and details about siblings.
12. Answer the questions regarding your child's health, education, development, and medical care, ensuring all relevant details, including previous injuries or serious illnesses, are provided.
13. Lastly, share information regarding your child's interests, strengths, and any additional information that might be relevant for a comprehensive assessment.
14. After completing all sections, ensure to save any changes, download the form, print it out for your records, or share it with the necessary parties.

Complete the Intake Assessment Example online today to ensure your child's needs are addressed.