Follow the steps to successfully complete your client intake information form.

1. Click ‘Get Form’ button to acquire the intake information form and open it in your chosen editor.
2. Begin by entering your full name in the designated fields for First, Middle, and Last names. Make sure to provide accurate details as this information is essential for your records.
3. Indicate your sex by selecting the appropriate option. Then, enter your age and date of birth in the specified formats.
4. Input your place of employment and occupation details.
5. Provide contact information including home, work, and cell phone numbers, as well as personal and work email addresses, ensuring permission is granted for communication.
6. If applicable, include information for a spouse, fiancé, parent, or guardian. Repeat the steps for name, address, age, etc., for this individual.
7. Indicate how you heard about eXtraordinary Life and briefly explain your reason for seeking counseling in the provided space.
8. List family members living at home, their ages, and their relationships to you.
9. Complete the legal authorization section for child clients if applicable, ensuring to answer questions about emotional treatment authorization.
10. Fill out the medical and health information, including your personal physician's details, any major illnesses, medications, and prior counseling experiences.
11. Indicate emergency contact information and give authorization for the release of client information if necessary.
12. Read and initial the policies and procedures section, ensuring you understand the counseling fees and payment adjustments.
13. Sign and date the consent to treatment section, confirming your understanding of the terms and your willingness to participate.
14. After completing all sections of the form, review your entries for accuracy and then save your changes. You may download, print, or share the completed form as needed.

Start completing your intake form online today to take the first step towards your counseling journey.