Get Cpc Of Winnipeg - Client Intake Form.pdf - Crisis Pregnancy Centre ... 2020-2025

Completing the CPC Of Winnipeg - Client Intake Form is an important step in accessing the services provided by the Crisis Pregnancy Centre. This guide will help you navigate through the form with ease, ensuring that all necessary information is clearly and accurately filled out.

Follow the steps to complete the client intake form effectively.

1. Press the ‘Get Form’ button to access the client intake form and open it in your preferred editor.
2. Begin by filling out the case number and the original counsellor's name at the top of the form. If you are being referred to a new counsellor, indicate their name and the date of the referral.
3. In the section labeled 'Client Intake Form – Confidential Information', provide your full name, age, and medical number. Ensure that today's date is accurately recorded. Indicate if this is your previous visit.
4. Mark your marital status by checking the appropriate box. Also, indicate your race and religious preference in the specified fields. Next, describe how you learned about the centre and indicate if you give permission for them to call you.
5. When filling out the 'Client Related Information' section, document the first day of your last period and whether it was regular. Also, indicate your cycle length, whether you used contraceptives, and detail any previous pregnancies, miscarriages, or abortions.
6. Express your feelings regarding abortion and the possibility of being pregnant, as well as your initial intentions if a pregnancy test is positive.
7. Complete the pregnancy screening test results section by checking the appropriate outcome of your test and providing information on the gestational age and due date, if known.
8. In the 'Crisis Pregnancy Centre Services Used' section, check the services you wish to receive. Additionally, indicate any referrals you may need.
9. Utilize the notes sections to summarize discussions during your visit and your feedback. Record follow-up notes meticulously, including the type of contact and relevant dates.
10. Lastly, review all entered information to ensure accuracy. Once satisfied, you can save changes, download, print, or share the completed form as needed.

Start filling out your client intake form online today to access the support you need.