New Client Intake - Youth 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the client’s name and parent/guardian details in the General Information section. Ensure accuracy for effective communication.
3. Indicate if you are a previous client and provide the date of your last visit, if applicable. This helps us understand your history with our services.
4. Fill in the mailing address, phone numbers, date of birth, and age of the youth. This information is crucial for contact and service eligibility.
5. Select your income tier from the provided options. This will assist in determining any potential fees associated with services.
6. Answer questions regarding disabilities, medical conditions, and insurance coverage to ensure we can provide appropriate support.
7. Complete the Emergency Contact Information section by providing a reliable contact person and their relationship to you.
8. Review all entries for accuracy before submitting. Use our platform's features to save your progress or print a copy for your records.

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