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SUSAN POS ADA, PhD, MHC, LEFT, NB CCH 16614 N Dale Mary Hwy Tampa, Florida 33618 YOUTH AND FAMILY ASSESSMENT (To be completed by parents) CHILD NAME: DOB: GRADE: ADDRESS: CITY: STATE: ZIP CODE: PARENT
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How to fill out youth and family intake:

01
Start by gathering all necessary information about the youth and family that will be the subject of the intake form. This includes their names, ages, contact information, and any relevant background information.
02
Begin the intake form by providing the basic demographics of the youth and family, such as their addresses, phone numbers, and emergency contact information. This will ensure that the agency has the necessary contact details in case of any emergencies or follow-up.
03
Move on to the section where you will gather information about the youth's educational background, including their school name, grade level, and any notable academic achievements or challenges. This section is important for assessing the educational needs of the youth.
04
Next, include a section where you will ask about the youth's medical history, including any existing health conditions, medications, or allergies. It is essential to have this information to ensure the safety and well-being of the youth in any program or intervention.
05
Include a section to gather information about the family background, including living arrangements, family members, and any support networks or resources available to the family. This will give the agency a better understanding of the youth's family dynamics and support system.
06
Consider including a section that specifically asks about the reason for seeking assistance or intervention. This can help the agency to tailor their services to the specific needs of the youth and family. Encourage the youth and family to provide detailed information in this section to ensure that they receive the necessary help and support.
07
Lastly, include a section for any additional comments or concerns that the youth or family may have. This can serve as an opportunity for them to express any specific needs or preferences they have in terms of the assistance or intervention they are seeking.

Who needs youth and family intake?

01
Families who are seeking assistance or support for their children or youth.
02
Youth who require intervention or services to address specific challenges they may be facing.
03
Professionals or organizations in the field of youth and family services who need to gather essential information for assessment and program planning purposes.
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Youth and family intake is the process of gathering information and assessing the needs of youth and families who may require support or intervention.
Professionals such as social workers, counselors, and teachers are typically required to file youth and family intake forms.
Youth and family intake forms can be filled out by providing detailed information about the youth and family's situation, needs, and any potential risks or concerns.
The purpose of youth and family intake is to identify and address the needs of youth and families in order to provide appropriate support and services.
Information such as the youth's name, age, living situation, familial relationships, and any existing challenges or concerns must be reported on youth and family intake forms.
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