Get the free Adolescent Intake Form (12-17) - mibehavioralhealth.com

Adolescent Intake Form (1217) Welcome to Michigan Institute for Behavioral Health, LLC. Please note that the information is important for your care. Please fill out forms as completely as possible

How to fill out adolescent intake form 12-17

How to fill out adolescent intake form 12-17:

1. Start by ensuring that you have the correct form. The adolescent intake form 12-17 is typically used by healthcare providers, counselors, or other professionals who work with teenagers between the ages of 12 and 17.
2. Begin by providing basic information about the adolescent, such as their name, date of birth, and contact information. This includes their address, phone number, and email address if applicable.
3. Next, you may be asked to fill in information about the adolescent's medical history. This can include any current or past medical conditions, medications they are taking, and any known allergies. It's important to be as thorough and accurate as possible when providing this information.
4. The form may also ask about the adolescent's mental health history, including any previous diagnoses, treatment received, or any mental health medications they are currently taking. Again, it's important to be honest and provide all relevant information.
5. The form may also include sections for the adolescent's educational history, such as their current school, grade level, and any special education needs they may have.
6. Depending on the purpose of the form, there may be additional sections asking about the adolescent's family history, social and emotional well-being, and any current concerns or issues they may be facing.
7. Make sure to read through the entire form before submitting it, to ensure that all sections have been completed accurately. If you have any questions or are unsure about how to fill out a certain section, don't hesitate to reach out to the person or organization who provided you with the form for clarification.

Who needs adolescent intake form 12-17:

1. Healthcare providers: Adolescent intake forms are commonly used by healthcare providers, such as doctors, nurses, and therapists, to gather important information about their adolescent patients. This information helps them to provide appropriate and personalized care.
2. Counselors and therapists: Adolescent intake forms are also used by counselors and therapists who work with teenagers. These forms help professionals gain a better understanding of the adolescent's background, concerns, and goals, which guides their treatment approach.
3. Schools and educational institutions: Some schools or educational institutions may use adolescent intake forms as part of their enrollment process or to gather information for student services. This can include information about the adolescent's academic history, special education needs, or any additional support they may require.
4. Social service agencies: Social service agencies may also utilize adolescent intake forms when working with teenagers and their families. These forms can help agencies assess the needs of the adolescent and provide appropriate support and resources.

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