Get Pca Client Intake Form

Completing the PCA Client Intake Form online is a crucial step in accessing mental health services. This guide will provide you with clear and supportive instructions for each section of the form, ensuring the process is simple and efficient.

Follow the steps to fill out the PCA Client Intake Form online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by entering your personal information in the 'Client' section. Fill in your name, address, and social security number as prompted. Ensure that you provide both your physical address and mailing address if they differ.
3. Input your telephone numbers in the designated fields, including home, cell, and work. If you prefer, you can request that no calls be made to your home or work.
4. In the ‘Emergency Contact’ section, provide the name, relationship, and contact details for someone who can be reached in case of an emergency.
5. List the members of your current household, including their ages and relationships to you, in the respective section.
6. Proceed to the 'Education' section and circle the highest grade level you have completed. Provide any degrees earned and the name of your current school if applicable.
7. Fill in your employer's name and address in the appropriate fields. Also, include your occupation.
8. Indicate how you were referred to Pettigru Counseling and whether you allow acknowledgment of the referral.
9. Provide a brief description of your current situation and the reason you are seeking services from Pettigru Counseling.
10. If you have previously received mental health services, clarify by selecting 'Yes' or 'No' and providing the necessary details for the previous services.
11. Complete the health history sections, including current medications, health problems, family history of medical issues, and any relevant health concerns for children if applicable.
12. Review the 'Assignment of Insurance and Release of Information Regarding Billing' section carefully. If you agree, sign and date it to grant authorization for Pettigru Counseling Associates to release necessary information to your insurance.
13. Finally, ensure all fields are accurately filled, and when ready, save changes, download, print, or share the completed form as needed.

Fill out your PCA Client Intake Form online today to start your journey towards receiving support.