Get Connie Hurdle, Ms

The Connie Hurdle, MS intake form is essential for initiating psychotherapeutic services. This guide provides clear, step-by-step instructions to assist you in completing the form online efficiently and accurately.

Follow the steps to fill out the Connie Hurdle, MS intake form online.

1. Press the ‘Get Form’ button to access the intake form and open it in your preferred document editor.
2. Begin by filling out the identifying information section, including your name, sex, birth date, age, Social Security number, and driver’s license number.
3. Provide your contact numbers and indicate if it is okay to reach you there, as well as if messages can be left.
4. Fill in your residence address and confirm whether you allow mail to be sent there.
5. Complete the email address field and again indicate if you consent to mail being sent there.
6. Input your occupation and work telephone number, as well as indicate your preferences regarding calls and messages.
7. Describe how you heard about Family Relational Therapy or The Play Therapy Cottage, and note whether you permit a thank-you to the person who referred you.
8. In the emergency contact section, provide the name, relationship, and telephone number of a person to be contacted if necessary.
9. Proceed to the physical history section and answer questions regarding your last physical examination, serious medical conditions, serious head injuries, and current medications.
10. Detail your social history by providing information on your birthplace, number of siblings, education, partnership history, and number of children.
11. Address your mental health history, noting previous concerns, treatments, and current mental health professional support.
12. Complete the alcohol and drug use section, detailing any past or present substance use.
13. Fill in the sexual abuse history section, if applicable, articulating experiences and treatments.
14. Indicate any history of violence or suicide risk, including any previous concerns.
15. Describe the reasons you believe you need therapy and your expectations for the outcomes of the encounter.
16. After ensuring all information is accurate and complete, save your changes, and choose to download, print, or share the form as needed.

Complete your Connie Hurdle, MS intake form online to take the first step towards receiving therapeutic support.