Follow the steps to successfully complete the intake form.

1. Press the ‘Get Form’ button to access the initial parent intake form and open it in an online editor.
2. Begin by entering the date at the top of the form using the month, day, and year format. This information is essential for record-keeping.
3. Next, enter the name of the person completing the form along with their relationship to the child. This helps the clinic understand the context of the submission.
4. Input your child’s legal name and date of birth, ensuring you check the age calculation is correct.
5. Fill in your child's address and preferred language for communication. Ensuring clear communication is vital, especially regarding medical concerns.
6. Select the preferred method for receiving automated messages regarding the intake process, and indicate if an interpreter is required.
7. Indicate any custody issues or protective orders if applicable, providing a brief description if 'yes' is selected.
8. Complete the section for legal guardians, including names, addresses, and relationships to the child. It's crucial for determining who is authorized to make decisions.
9. Provide details on parents' marital status, and fill out any information regarding the primary care doctor and their contact details.
10. Document insurance information, including primary and secondary coverage, subscriber details, and policy numbers.
11. Articulate the primary reasons for the visit, specifying who referred you and your specific concerns. Your clarity here will assist in directing appropriate evaluations.
12. Detail any medications your child currently takes, including purpose, dosage, and how long they have been prescribed.
13. List any medical history relevant to the child's current health status, ensuring to describe any existing diagnoses or concerns.
14. If applicable, provide information on any professional evaluations that have previously been conducted along with the corresponding provider details.
15. Summarize any additional comments or considerations you feel are important for the clinic to be aware of regarding your child.
16. Complete the attestation section, confirming that you have provided accurate information and understand the implications for the evaluation process.
17. Once you have filled in all required fields, review the form for completeness and accuracy. Then save your changes, download, print, or share the form as needed.

Take action now by completing the NY RGH DBP Initial Parent Intake form online to ensure a smooth evaluation process for your child.