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How to use or fill out NEW PATIENT INTAKE - CHILD ADOLESCENT - PAGE 1 with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by entering the 'Date of Initial Appointment' and 'Date of Birth' for the child. This information is crucial for scheduling and record-keeping.
- Fill in the 'Patient’s Full Name' and 'Age'. Ensure accuracy as this will be used for identification purposes.
- Provide the names of the 'Parent(s) / Guardian(s)' along with their relationship to the child. This helps establish who is responsible for the patient.
- Indicate if there was a referral by selecting 'Yes' or 'No', and if applicable, specify who referred you.
- Complete the section on how you heard about our office by checking all relevant options, such as 'Website', 'Google Search', or others.
- In the 'Reason for your appointment' field, briefly describe why you are seeking help. This sets the context for your visit.
- Check any current symptoms that apply from the provided list. This assists in understanding the child's mental health status.
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