Get Stenzel Clinical Services Client Intake Form 2014

Completing the Stenzel Clinical Services Client Intake Form is an essential step towards receiving personalized therapy tailored to your needs. The following guide provides clear, step-by-step instructions on how to fill out the form online, ensuring a smooth intake process.

Follow the steps to successfully complete the Client Intake Form.

1. Press the ‘Get Form’ button to access the Client Intake Form. This will allow you to open the document for completion.
2. Enter your full legal name and the current date in the designated fields. Make sure to provide the exact name as it appears on official documents.
3. Fill out your address, including the city, state, and zip code. Check for accuracy as this information is vital for communication.
4. Provide your home and cell phone numbers. If you are a child, include the second parent's phone number as well.
5. Enter your date of birth and specify whether Stenzel Clinical Services will be billing your PPO insurance. If applicable, provide your subscriber relationship to the client.
6. If not yourself, complete the subscriber's information including their name, date of birth, and address, if different from yours.
7. Indicate your place of employment, job title, and how long you have worked in your current role.
8. Select your highest level of education completed and marital status from the provided options.
9. If married, enter your spouse's name and date of birth, along with their occupation and employer's name.
10. List the names and ages of any children, using the provided fields.
11. Indicate how you were referred to Stenzel Clinical Services, selecting the most relevant option.
12. If you identify with any specific racial or ethnic group, please note it to provide your therapist with relevant context regarding your background.
13. Indicate whether you consider your spiritual life a resource and provide information about your religious affiliation, if desired.
14. Complete the background questions regarding your parent's names, ages, and any relevant history regarding counseling or substance abuse within your family.
15. Provide information on any personal medical conditions, current medications, and their prescribing physician.
16. Answer questions about your alcohol or drug usage history and your previous therapy experiences, detailing when and with whom you attended therapy.
17. Lastly, detail your reason for seeking therapy and any additional information you feel is important to the counseling process.
18. Once you have filled out all sections of the form, be sure to review your responses for accuracy. You can then save the form, download, print, or share it as needed.

Begin the intake process today by completing the Stenzel Clinical Services Client Intake Form online.