CLIENT INTAKE FORM - New Perspectives Counselling - newperspectivescounselling 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering today's date and the therapist's name at the top of the form. Select the session type that applies to you from the provided options.
3. In the 'Personal Information' section, fill in your last name, first name, middle name, and select your title (Mr., Mrs., Miss, Ms.). Provide your street address, occupation, marital status, birth date, city, postal code, and contact numbers.
4. Indicate whether you consent to receive messages on your home and cell phones. Fill in your email address and confirm if you allow communication via email.
5. Complete the 'Referral Information' section by selecting services of interest and answering questions about previous counseling experiences.
6. Describe any difficulties you're experiencing and list three goals for counseling. Finally, indicate how you heard about New Perspectives.
7. If applicable, complete the section for anger management or legal involvement cases. Provide consent details for information disclosure if necessary.
8. Fill out insurance information if you have Extended Health Care Benefit Coverage. Include provider details and coverage specifics.
9. Review all sections for accuracy before saving or submitting your completed form.

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