Medicaid Client Intake Form - DuPont Counseling Services 2026

1. Click ‘Get Form’ to open the Medicaid Client Intake Form in the editor.
2. Begin by entering your personal information at the top of the form, including your name, Social Security number, and Medicaid number. Ensure accuracy as this information is crucial for processing.
3. Proceed to the 'Presenting Problems' section. Here, list any issues you are currently facing and indicate how long you have experienced these problems. This helps your counselor understand your situation better.
4. In the 'Current Symptom Checklist', rate each symptom based on its intensity. Use the provided scale from 'None' to 'Severe' to accurately reflect your current state.
5. Continue through sections like 'Emotional/Psychiatric History' and 'Family History', providing detailed responses where applicable. This information is vital for a comprehensive assessment.
6. Once all sections are completed, review your entries for accuracy before submitting. You can easily make edits using our platform's intuitive editing tools.

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