Get the free Client Intake and History Form - Spokane Resource Group

Spokane Resource Group Sarah Parker, MA, LEFT 5093891494 Phone 1817 E. Springfield Ave., Suite E Spokane, WA 99202 5095354069 Fax Client Intake and History Form Date: Date of Birth: Name: Spouse/Partners

How to fill out client intake and history

How to fill out client intake and history:

1. Begin by gathering basic client information such as their full name, date of birth, address, and contact information.
2. Create a section for the client to provide their medical history, including any previous diagnoses, surgeries, or current medications they are taking.
3. Include a section for the client to disclose any allergies or sensitivities they may have.
4. Ask the client to provide details about their lifestyle habits, such as their diet, exercise routine, and any tobacco or alcohol use.
5. Include a section for the client to share any mental health concerns or previous counseling experiences they may have had.
6. Create a space for the client to describe their current reasons for seeking assistance or counseling.
7. It may also be helpful to ask the client about their support system and whether they have any current stressors or challenges in their life.
8. Finally, provide an area for the client to sign and date the intake form, acknowledging that the information they provided is true and accurate.

Who needs client intake and history:

1. Mental health professionals such as therapists, counselors, or psychologists typically require client intake and history forms before beginning any treatment.
2. Medical professionals may also need client intake and history information to better understand a patient's overall health and customize their care.
3. Rehabilitation centers or addiction treatment facilities often require client intake and history forms to assess and plan appropriate treatment strategies.

For pdfFiller’s FAQs

What is client intake and history?

Client intake and history is a process of gathering information about a client, including personal details, medical history, and legal background.

Who is required to file client intake and history?

Any professional or organization providing services to a client is required to file client intake and history.

How to fill out client intake and history?

Client intake and history forms can be filled out electronically or on paper, and typically require information such as name, address, contact details, medical history, and reason for seeking services.

What is the purpose of client intake and history?

The purpose of client intake and history is to gather necessary information to provide appropriate services, ensure client safety, and establish a professional relationship.

What information must be reported on client intake and history?

Information such as personal details, medical history, legal background, reason for seeking services, and any relevant information that may impact the services provided.

How do I complete client intake and history online?

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