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Family intake 2026

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  1. Click ‘Get Form’ to open the Family Intake Form in the editor.
  2. Begin by filling out the Family Information section. List all individuals present for counseling, starting with the father's details including name, phone number, and address. Ensure you provide a safe mailing address if necessary.
  3. Next, complete the mother's information using the same format as above. If her address is the same as the father's, simply check the box provided.
  4. Proceed to list children's names and ages. If applicable, indicate any stepsibling relationships next to their names.
  5. Address mental health questions by selecting 'Yes' or 'No' for each inquiry regarding suicidal history or hospitalization within the immediate family.
  6. In the Reasons for Seeking Family Counseling section, articulate your family's needs and expectations from therapy.
  7. Complete additional sections on family strengths, weaknesses, conflict resolution strategies, and regular activities together.
  8. Finally, provide emergency contact information and ensure all signatures are completed before submitting your form.

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Related links

3.0 Introduction to Intake

The Intake Assessment begins the process of comprehensively assessing child safety by gathering information to assist in locating the problems and behaviors.Read more

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Family Intake Form - CISWH - Boston University School of

This form prompts families to think about concerns, priorities, and unmet needs for their child before their care coordination intake visit.Read more

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