Follow the steps to successfully complete the Family Intake form.

1. Press the ‘Get Form’ button to access the Family Intake form and open it in your preferred editing tool.
2. Begin by indicating the client type by selecting the appropriate option: Adult, Child, Couple, or Family. Fill in the intake date as well.
3. Provide your full name, including first, middle, last, and maiden names, followed by your complete address which includes the street, apartment number, city, state, and zip code.
4. Enter your phone numbers accurately, including home, daytime, and cell numbers. Indicate whether messages regarding your appointments can be left and provide a phone number if different from your main contacts.
5. List your email address and specify if you consent to receive appointment-related emails.
6. Fill in your date of birth, age, and sex. Provide your Social Security number and details about your occupation and place of employment.
7. Indicate your marital status and, if necessary, your annual household income for sliding scale purposes.
8. For insurance purposes, provide information about your primary and secondary insurance, including the name of the insured, their Social Security number, and their date of birth.
9. Complete sections on your educational level, referral reasons, and employment status, checking all relevant boxes.
10. List emergency contact details, including name, relationship to you, and their phone number.
11. Provide insight into your current situation by summarizing why you seek counseling and what you hope to gain from it.
12. Gradually fill in the sections related to personal history, health history, current family, family of origin, substance use, and spiritual values, ensuring to answer all questions as thoroughly as possible.
13. Finally, review all entered information for accuracy before saving your changes. You can then download, print, or share the completed form as needed.

Get started on your healing journey by filling out the Family Intake form online today.