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11760 W. Sample Road, Suite 101 Coral Springs, Florida 33065 Phone (954) 3455644 Fax (954) 3455683 Center for Psychological Wellness, Inc. www.psychwell.com NEW CLIENT INTAKE FORM (CHILD/ADOLESCENT)
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Start by opening the formnewcltintakechilddoc document on your computer.
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Begin by entering the child's personal information such as their name, date of birth, and gender.
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Provide the child's contact details including their address, phone number, and email (if applicable).
04
Indicate the child's relationship to the client or guardian, whether they are the client's child, stepchild, or another relation.
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Move on to the section asking for information about the child's other parent or legal guardian. Fill in their name, address, and contact details.
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If there is any custody arrangement in place, specify the details in the designated section.
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Clients or their legal representatives who are seeking legal services for their child.
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Organizations or agencies that offer legal support or advocacy for children and families may utilize this form as part of their intake process.
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