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Firefly Counseling Services, P.C. 4950 NE Belong Ct. Suite 205 Hillsboro, OR 97124 5035605822 (voice) 8885032864 (fax) www.fireflycounselingservices.com Child Intake and Evaluation Form Part I: To
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How to fill out child intake and evaluation:

01
Start by gathering all necessary information about the child, including their personal details such as name, age, and contact information.
02
Fill out sections related to the child's medical history, including any past illnesses, medications, or allergies.
03
Provide information about the child's developmental milestones, such as when they started walking, talking, or reaching other important milestones.
04
Record any concerns or observations about the child's behaviors or social interactions.
05
Include information about the child's educational background, including any previous schooling or early intervention programs they have been a part of.
06
Provide details about the child's family and home environment, including their immediate family members and any additional support they receive.
07
It is important to be thorough and accurate when filling out any assessment or evaluation forms. Take your time and ensure that all information provided is correct.
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Once you have completed filling out the child intake and evaluation form, review it for any errors or missing information before submitting it.

Who needs child intake and evaluation?

01
Parents or caregivers who are seeking services or assistance for their child's development or well-being may need to complete a child intake and evaluation form.
02
Schools or educational institutions may require child intake and evaluation forms as part of the enrollment process, especially for children entering a new program or grade level.
03
Therapists, psychologists, or other healthcare professionals who are providing services to children may use child intake and evaluation forms to gather important information about a child's background and needs.
04
Government agencies or social service organizations may also utilize child intake and evaluation forms to assess and provide support for children and families in need.
05
Childcare centers or daycare facilities may require parents to fill out child intake and evaluation forms to ensure the child's safety and well-being while in their care.
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Child intake and evaluation is a process used to assess the needs and well-being of a child, often conducted by social workers or child welfare agencies.
Child intake and evaluation may be required to be filed by social workers, child welfare agencies, or caregivers of the child.
Child intake and evaluation forms typically require information about the child's living situation, family dynamics, any potential abuse or neglect, and the child's physical and emotional well-being.
The purpose of child intake and evaluation is to ensure the safety and well-being of children, identify any potential risks or concerns, and provide appropriate interventions or services.
Information reported on child intake and evaluation forms may include the child's name, age, living situation, family members, any history of abuse or neglect, and any current concerns or observations.
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