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Child/Adolescent Intake Form Client's name

Child/Adolescent Intake Form Client's name 2025

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The document is a Social Thinking® Intake Form designed for parents or guardians to provide essential information about their child for participation in a collaborative counseling group. It includes sections for personal details, educational placement, mental health and learning diagnoses, medication, behavioral concerns, previous therapy experiences, and expectations from the group. The form aims to gather comprehensive insights into the child's communication abilities, anxieties, and any additional relevant information to facilitate effective support.

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Click ‘Get Form’ to open the Child/Adolescent Intake Form in the editor.
Begin by entering the date at the top of the form. This helps track when the intake is completed.
Fill in the parent’s names and child’s name in the designated fields. Ensure accuracy for effective communication.
Provide your child's date of birth, school, and grade. This information is crucial for understanding your child's educational context.
Complete the address, contact number, and email sections to facilitate easy follow-up.
Indicate how you heard about this group, as it can help us improve outreach efforts.
Answer questions regarding your child's educational placement and any mental health or learning disorders. Be as detailed as possible for better support.
List any medications your child is currently taking along with their dosage and duration.
Describe your current concerns about your child’s behavior and communication abilities in the provided sections.
Finally, provide any additional information that may be helpful for understanding your child better before signing and dating the form.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (77 Votes)
2016	3.7 Satisfied (29 Votes)
2013	4 Satisfied (23 Votes)

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What do you call an intake form?

Whats an intake form? An intake form helps service providers streamline the client onboarding process and easily gather information from new clients. This questionnaire is a way for you to get to know your clients in the early stages of your relationship with them.

What information is on an intake form?

Your client intake form is a tool to obtain accurate and up-to-date information from a new client that you need to perform your job. This may include answering questions, locating paperwork, or providing you with usernames and passwords for certain applications.

What should an intake form include?

Intake Form Example Use Case: Client Intake The process usually begins with an information form being completed either by the client or the vendor. The information may include the following: Client point of contact details. Additional client contacts information.

What is the purpose of intake form?

What should a client intake form include?

A client intake form is a questionnaire an agency uses to essentially onboard its clients. It asks a client to provide information that can help an agency both determine whether that client is a good fit for its services and shape a strategy to address that prospects needs, interests, and pain points.

How do I create a fillable intake form?

How to create a client intake form Step 1: Click on Create New Form. Step 2: Select if you want to create from scratch or if you prefer to use a free template. Step 3: Name your Form. Step 4: Drag and drop the form fields. Step 5: Put the fields applicable to your business. Step 6: Format each field.

What should be in an intake form for counseling?

Client Forms for Counseling and Mental Health Intake form: On an intake form, a patient should provide their full name, gender, date of birth, address, contact information and information about their insurance company.

Can I use Google Forms for client intake?

Creating an Intake form with Google Forms. To create your intake form, go to and click the Plus sign to create a new form. Name your form: In the top-left corner, click Untitled form or the template form name and enter a new name. Add a description: Under the form name, add your text.

Child/Adolescent Intake Form Client's name 2025

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