Follow the steps to complete the form online.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin with the section labeled 'Client Intake And Information Form.' Enter your full name, including first, middle, and last names, followed by your date of birth, and client number if applicable. Ensure accuracy as this identifies your records.
3. In the address section, fill out your complete address, including city, state, and zip code. This is vital for communication purposes.
4. Provide contact information, including home and work phone numbers. You may also need to include your Social Security number for identification.
5. Indicate your age, gender, and marital status using the provided checkboxes. This information may assist in tailoring your assessment and treatment.
6. Respond to demographic questions, including race, education level, and whether you have children. These factors help in understanding your background.
7. There are questions regarding family history with alcohol or drugs. Indicate whether this applies to family members by checking 'Yes' or 'No.'
8. If applicable, check whether you have served in the military and provide branch information.
9. State your reason for seeking services in the designated area. This brief statement is important for the assessment process.
10. Complete the section that asks for referral information. It may be helpful to specify who informed you about the agency.
11. If you have previously been a client, provide the date of past services. Record any arrests related to substance use, including DWI incidents.
12. You will need to sign the client attestation, confirming that the information you provided is accurate. This signature is necessary for the form's validity.
13. After completing, you can save your changes. Use the options to download, print, or share the form as needed for your records.

Start filling out your Client Intake Form online today to begin your assessment process.