Adolescent Intake Information - Counselor Children 2026

1. Click ‘Get Form’ to open the Adolescent Intake Information in the editor.
2. Begin by filling out the Legal Guardian/Parent Information section. Enter the name, date of birth, address, and contact numbers for both parents or guardians.
3. In the Family/Friend Relationships section, indicate with whom the youth currently lives and provide details about their relationships. Use a scale from 1 to 5 to rate how well the youth gets along with each person listed.
4. Complete the Medical Information section by providing details about the primary physician, any chronic illnesses, and current medications. Be sure to include dosage and frequency.
5. In the Counseling Information section, describe the main concerns that prompted seeking counseling. This is an opportunity to express thoughts on what you hope to achieve through therapy.
6. Finally, review all entered information for accuracy before saving or printing your completed form for submission.

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