Get Caramenico Counseling Group Client Information Form 2017-2025

Completing the Caramenico Counseling Group Client Information Form online is a straightforward process that helps ensure your personal information is accurately captured for your counseling services. This guide will take you through each section of the form to facilitate a seamless experience.

Follow the steps to successfully complete the Client Information Form online.

1. Press the ‘Get Form’ button to access the online form. When you do this, the document will open for you to begin filling out.
2. In the first section, enter your full name, Social Security Number (SSN), and date of birth (D.O.B.) accurately to establish your identity.
3. Provide your current address and telephone number. Make sure to include your cell number if applicable.
4. Indicate whether it is okay to leave a message on your telephone and if you consent to receive text messages.
5. Fill in your email address and specify if you are comfortable receiving emails.
6. Select your preferred contact method by checking the appropriate box for telephone, cell with voicemail, or cell with text messages.
7. If you are completing this form for a client under the age of 14, please provide the names of the client's parents or guardians.
8. In the primary insurance information section, enter the details of your insurance carrier, including the insurance ID number, group number, policy holder's name, and their date of birth.
9. State the relationship of the policy holder to the client and provide the insurance contact number along with information about copays, deductibles, and coinsurance.
10. If applicable, provide secondary insurance information following the same format as primary insurance.
11. In the background information section, describe your presenting concern and any legal matters, if relevant. Consent for communication with your primary care physician can also be provided here.
12. Complete the medical history section by listing any allergies, major medical conditions, recent hospitalizations or surgeries, current medications, and history of head trauma.
13. For clients aged 4-17, address any developmental delays and provide prenatal and perinatal history.
14. For children aged 4-17, ensure to confirm vaccination and wellness visit status, including dental visits.
15. In the psychiatric/mental health history section, fill out any relevant information regarding past hospitalizations or treatments.
16. If applicable, detail any history related to drug and alcohol use, including past treatments.
17. Finally, for court involvement, indicate any relationships to probation or welfare services and provide explanation as necessary.
18. After completing all fields, review the form thoroughly for accuracy and completeness before saving your changes. You may download, print, or share the form based on your needs.

Complete your documents online today to ensure prompt and accurate service.