Get New Client Intake Form Demographic Information

Filling out the New Client Intake Form Demographic Information is an important step in your journey toward receiving support. This guide provides a clear, step-by-step approach to help you complete the form accurately and easily.

Follow the steps to complete your demographic information.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated field provided at the top of the form. Ensure accuracy as this will identify you in the system.
3. Next, input the current date and your date of birth. This information is essential for demographic purposes.
4. Specify your age in the field provided. This helps us understand your demographic context.
5. Select your sex from the options given. If you prefer not to specify, check for any additional options that may be provided.
6. Fill in your birthplace along with your full street address, including city, state, and zip code. This information is necessary for communication purposes.
7. Provide your phone number(s) and indicate whether it is acceptable to leave a voicemail.
8. Enter your email address and specify if you would like to receive email communication.
9. Indicate if it is acceptable to send correspondence by mail.
10. Describe how you found out about the service, including any specific keywords you used if applicable.
11. If applicable, fill out the additional client section with the same required details as instructed.
12. In the ‘Getting to know you’ section, articulate your three biggest concerns and any relevant past therapy experiences.
13. Continue through the form by answering questions regarding your wellness practices, medical history, and personal backgrounds.
14. Complete all sections, ensuring all mandatory fields are filled out, such as medical and wellness information, personal history, and relationships.
15. Review your entries carefully to ensure everything is accurate and complete.
16. Once finished, save any changes made, and you can choose to download, print, or share the completed form as necessary.

Complete your New Client Intake Form online today to begin your path toward support.