Client Intake Form - Precourt Counseling Services 2026

1. Click ‘Get Form’ to open the Client Intake Form in the editor.
2. Begin by filling out your Client Contact Information. Enter your first and last name, gender, Social Security Number, and date of birth. Ensure that your address is complete, including city, state, and zip code.
3. Next, provide your home and cell phone numbers. If you are a minor, include the name of your parent or guardian.
4. Proceed to the Emergency Contact Information section. Fill in the contact's name, phone number, and relationship to you.
5. In the Billing Insurance Information section, enter details for your primary and secondary insurance providers. Include member IDs and policy holder information as required.
6. Review the Insurance Authorization and Assignment section carefully. Sign and date where indicated to authorize insurance claims processing.
7. Complete any additional sections as necessary, such as consent forms or acknowledgment of rights and responsibilities.

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