Intake assessment example 2026

1. Click ‘Get Form’ to open the intake assessment example in the editor.
2. Begin by filling out the 'Identifying Information' section. Enter the child's name, today's date, date of birth, age, grade, sex, race/ethnicity, and social security number. Ensure all fields are completed accurately.
3. Proceed to the 'Mother’s Information' section. Fill in details such as name, date of birth, home phone number, address, race/ethnicity, and employment status. Check the appropriate boxes for marital status and provide any special calling instructions.
4. Continue with the 'Father’s Information' and 'Step-parent’s Information' sections using similar guidelines as above. Make sure to include all relevant details.
5. In the 'Reason for Seeking Treatment' section, describe your child's issues and what you hope to achieve through treatment. Be thorough yet concise.
6. Complete the remaining sections regarding family history, education, development, medical care, and interests. Each section is designed to gather comprehensive information about your child.

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