Children's Intake Form - Biofeedback 2025

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52 votes

The document is an intake form for a child seeking mental health counseling and therapy services at Biofeedback, Mental Health Counseling & Creative Arts Therapy, PLLC. It collects identifying information about the child and their family, medical and developmental history, educational background, social history, and specific behavioral concerns. Additionally, it includes a section for the release of information regarding the child's treatment.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Identifying Information section. Enter your child's name, sex, date of birth, and grade in school. This information is crucial for establishing a profile.
Next, provide details about the parents or guardians. Include names, dates of birth, and their relationship to the child. This helps in understanding family dynamics.
In the Presenting Problems section, check all applicable issues your child may be facing. This will guide the therapist in tailoring their approach.
Complete the Medical History section by indicating any past hospitalizations or medications. This information is vital for comprehensive care.
Fill out Living Arrangements and Developmental History sections to give context about your child's environment and growth milestones.
Finally, review all entries for accuracy before submitting your form through our platform for processing.

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Versions	Form popularity	Fillable & printable
2013	4 Satisfied (52 Votes)

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