Get Ca Alice Petty-hannum Client Intake Form 2014-2025

Filling out the CA Alice Petty-Hannum Client Intake Form online is an important step in initiating your counseling process. This guide will provide you with clear, step-by-step instructions on how to complete the form efficiently and accurately.

Follow the steps to successfully fill out the form

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering today's date in the designated field. This helps ensure your information is current and relevant.
3. In the section labeled 'Name of person filling out this form,' provide your full name. Then, indicate your relationship to the client in the following field.
4. Fill in the client's name, birthdate, and age accurately. This is crucial for establishing their identity.
5. Provide the client's address, including home telephone, alternative phone number, and town/zip code. Ensure these details are correct for future communication.
6. Indicate whether it is acceptable to leave a message on the provided phone numbers. This is necessary for privacy considerations.
7. Complete the section about household members by listing who you live with and your relationship to each person.
8. Next, fill in the racial/ethnic background and religious affiliation fields as they pertain to the client.
9. Provide the client's educational background and military history, if applicable. This information helps in understanding the client's background.
10. Discuss marital or relationship status, including how long the relationship has lasted and any previous marriages.
11. List your children, if applicable, including their names, ages, types (biological, adopted, etc.), and custody information.
12. Answer questions regarding family background, including details about parents and siblings.
13. Complete the health history section, detailing any current or past medications, health issues, and regular physician care.
14. Provide information about substance use by detailing types of substances, usage patterns, and any related concerns.
15. Answer assessment questions regarding past psychological issues, therapy experiences, and current concerns.
16. Fill out the emergency contact information, ensuring it is accurate and easy to reach.
17. Make sure to review all sections carefully to ensure completeness and accuracy.
18. Once you have filled out the form, you can save your changes, download the document, print it, or share it as needed.

Start completing your CA Alice Petty-Hannum Client Intake Form online today for a smooth and efficient process.