Family Support Intake Form 2026

1. Click ‘Get Form’ to open the Family Support Intake Form in the editor.
2. Begin by entering the date at the top of the form. This helps track when the intake process started.
3. Fill in the name of the family member with a severe or developmental disability, along with their Social Security number and date of birth.
4. Provide details for the primary family member(s) if different from above, including their address, phone number, county, and email address.
5. In the 'Reason for Referral' section, describe how the disability impacts your family. This information is crucial for understanding your needs.
6. Check off the primary disability category that best fits your family member's diagnosis from the provided list.
7. Indicate when the primary disability occurred by selecting either 'Prior to age 22' or 'At age 22 or after.'
8. Select any potential support services needed by checking all relevant boxes in that section.
9. List any other services received by checking applicable options in that section.
10. Complete any additional information you wish to provide and sign at the bottom of the form before submitting it.

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