Pediatric Mental Health Care Services - NSU Health 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal data, including your name, date of birth, and contact information. Ensure all fields are filled accurately for effective communication.
  3. In the 'Main Concerns' section, list the issues you wish to address in therapy. Use the provided scale to rate their severity, which will help your therapist understand your priorities.
  4. Complete the 'Medical History' section by indicating any serious medical conditions and current medications. This information is crucial for your treatment plan.
  5. Fill out the 'Current Stressful Events' and 'Family of Origin History' sections thoughtfully, as they provide context for your mental health needs.
  6. Review all entered information for accuracy before submitting. Utilize our platform's features to save or print a copy for your records.

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