Get Milestone Counseling Couples Intake Form

Filling out the Milestone Counseling Couples Intake Form online is an important step in starting your counseling journey. This guide will walk you through each section and field of the form, ensuring you can provide the necessary information comfortably and confidently.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the Milestone Counseling Couples Intake Form and open it in the digital editor.
2. Begin by entering the date at the top of the form. This helps to track when your intake information was submitted.
3. Select your title from the options provided, such as 'Mr.', 'Ms.', 'Miss', 'Mrs.', 'Dr.', or 'Rev.' This allows the counseling team to address you appropriately.
4. Indicate how you heard about Milestone Counseling. This information assists the practice in understanding referral sources.
5. Enter your full name, including last name, first name, and middle name. You can also provide any nickname or preferred name that you wish to be called.
6. Fill in your birth date and, if applicable, the name of your parent, guardian, or power of attorney.
7. For insurance clients, provide your social security number, along with your race, age, and sex to complete the demographic section.
8. In the contact information section, fill in your address, phone numbers, and email. Indicate if you wish to receive mail or messages at these contacts.
9. Provide an emergency contact’s name and their phone numbers, along with your relationship to them.
10. Share your employment information, including your employer, length of employment, occupation, and annual salary range.
11. Complete the education information by identifying the highest level of education completed and if you are currently in school.
12. In the relational information section, indicate your current status and provide additional details if necessary.
13. Fill out sections regarding your partner’s information, if applicable, including their general details and attitudes towards counseling.
14. Outline any children you have, listing their names, sex, ages, or year of death.
15. Detail family background information, including significant family members and their impact on you.
16. Provide primary physician information and any ongoing medical treatments or conditions.
17. List any current medications you are taking, indicating the purpose of each.
18. Check any physiological symptoms or sensations you are experiencing to help your counselor understand your current state.
19. Detail any current challenges or issues you face, alongside your level of distress using the provided scale.
20. Describe the reasons for seeking counseling and your goals for therapy.
21. List any previous counseling or psychiatric treatment received.
22. If relevant, provide information regarding your religious background and preferences for spiritual principles in counseling.
23. Review and sign the terms of service and give consent for Milestone Counseling to provide services.
24. Finally, save your changes. You can download, print, or share the completed form as needed.

Complete your Milestone Counseling Couples Intake Form online today to begin your path toward healing.