Get Intake Form This Is An Outline For The Intake Evaluation, Listing Sub ... - Usm Maine

Filling out the Intake Form is an essential step in the evaluation process. This guide will provide you with detailed instructions for each section of the form to ensure you complete it accurately and effectively.

Follow the steps to fill out the Intake Form accurately.

1. Click ‘Get Form’ button to access the document and open it in your preferred editing tool.
2. Begin by entering the identifying information. Fill in your name, date of birth, town of residence, age, and current status such as your job or grade.
3. Indicate the date of the intake evaluation in the designated field.
4. Complete the referral source section by noting who referred you and your relationship with that person.
5. Describe the referral problem clearly and objectively. Make sure to include both perspectives if there are differing views from the referral sources, detailing who holds each view.
6. In the history of problem/strengths section, provide a brief description of the problem's nature, extent, frequency, and any related physical symptoms. Also, outline any psychological or interpersonal strengths.
7. For social history, summarize your current social life including social skills, cultural background, activities you enjoy, and information about friendships and academic adjustment.
8. In the family history section, identify all family members, including the order of children and living arrangements. Include any details about intimate relationships and parents' educational, financial, and occupational status. Note any psychiatric or medical history within the family.
9. Describe your occupational history, detailing past and present jobs, reasons for job changes, and relationships with peers and supervisors. If you are a student, include information about your school history.
10. Finally, provide information regarding your medical history, including health status, date of last physical examination, attending physician, and any significant medical conditions.
11. After completing all fields, you may save changes, download, print, or share the form as needed.

Start completing your Intake Form online to ensure a smooth evaluation process.