Get Lifestance Health (formerly Western Psychological & Counseling) Services Child/adolescent Intake 2005-2025

Filling out the LifeStance Health Services Child/Adolescent Intake form online is a crucial step in ensuring your child receives the appropriate support tailored to their needs. This guide will lead you through each section of the form, providing detailed instructions to help you complete it with confidence.

Follow the steps to complete the Child/Adolescent Intake form easily and accurately.

1. Press the ‘Get Form’ button to access the intake form and open it for completion.
2. Begin by filling in your child’s name and the date at the top of the form.
3. In the 'Presenting problems and concerns' section, describe the primary issue that prompted the intake by providing a detailed narrative.
4. Check all behaviors and symptoms that you find to be problematic with your child, selecting from the provided list.
5. Indicate whether your child’s problems affect various aspects of their life by marking 'Yes' or 'No' for each option.
6. Answer questions regarding any thoughts, actions, or experiences related to self-harm or harm to others, ensuring to provide a descriptive response.
7. Proceed to the 'Family and developmental history' section, detailing family relationships and any mental health issues present.
8. Indicate if your child has experienced any specific trauma or loss by checking 'Yes' or 'No' as appropriate.
9. Next, complete the 'School information' section, listing your child’s current grade and any past academic issues.
10. If applicable, provide information under 'Substance use history' if your child is 12 years or older, detailing any current or past substance use.
11. Fill out the 'Medical information' section, including any relevant health conditions or medications your child is currently taking.
12. In the 'Interpersonal/social/cultural information' section, discuss your child’s support network and cultural background.
13. Lastly, complete the 'Legal information' section by providing details about custody arrangements or any legal issues.
14. Once all sections are complete, save your changes, and you will have the option to download, print, or share the completed form.

Complete the LifeStance Health Child/Adolescent Intake form online today for a smoother transition into supportive services.