Get the free Adolescent intake form - Aoife Earls, ND

Aífe Earls, B.Sc., M.Sc., ND Doctor of Naturopathic Medicine ADOLESCENT INTAKE FORM Date: Name Date of Birth Gender (please circle) Weight lbs Height F M dd×mm/by Age years CONTACT INFORMATION Address

How to fill out adolescent intake form

How to Fill Out Adolescent Intake Form:

1. Start by carefully reading the instructions provided on the adolescent intake form. This will help you understand the purpose of the form and the information required.
2. Begin by providing personal information such as the adolescent's full name, date of birth, gender, and contact details. Make sure to write legibly and accurately to ensure the form is processed correctly.
3. Next, fill in the section related to the adolescent's medical history. This may include information about past illnesses, surgeries, medications, allergies, and any significant medical conditions or mental health concerns. Be thorough and provide as much detail as possible.
4. The form might also ask for information about the adolescent's family history. Include details about any hereditary or genetic conditions that may run in the family, as this can help healthcare professionals better understand potential risk factors.
5. In some cases, the form may require information about the adolescent's academic background, such as their school name, grade level, and any special education services they may require.
6. If the adolescent has any current or ongoing treatment plans with other healthcare providers, provide the necessary details in the designated section. This could include the name and contact information of the healthcare professionals involved.
7. Along with medical information, the form may also inquire about the adolescent's mental health history. Share any relevant details regarding previous psychological evaluations, counseling, or therapy sessions.
8. Finally, review the completed form to ensure all sections are filled out accurately and comprehensively. Double-check for any missing information or errors before submitting it to the appropriate healthcare provider.

Who Needs Adolescent Intake Form:

1. Parents or guardians of adolescents who are seeking medical or mental health services for their children.
2. Healthcare professionals who require comprehensive information about the adolescent's medical and mental health history before initiating treatment or providing care.
3. Educational institutions or organizations that may need the form to obtain relevant information for academic or counseling purposes.

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