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TEXANS CENTER ADULT INTAKE FORM I Client Name: Case#: These Questions are asked for the purpose of helping assess total psychological functioning. You may, however, exercise the right to NOT ANSWER
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How to fill out texana center adult intake
How to fill out Texana Center Adult Intake:
01
Start by gathering all necessary personal information such as full name, address, phone number, date of birth, and social security number.
02
Indicate your gender, marital status, and whether you have any dependents.
03
Provide information about your current living situation, including the type of housing you reside in and the number of people living in your household.
04
Specify any legal or court involvement you may have, such as probation or ongoing legal cases.
05
Document your current employment status, including the name of your employer, job title, and income details.
06
Provide any details about your medical history, including any previous or ongoing mental health conditions, physical health issues, or medication you may be taking.
07
Indicate any substance abuse history, including drug or alcohol use, and whether you are currently receiving any substance abuse treatment.
08
Mention any previous or current experience with mental health services or counseling.
09
Describe the reason for seeking assistance from Texana Center, whether it is for mental health support, substance abuse treatment, or any other specific services.
10
Sign and date the intake form to validate the information provided.
Who needs Texana Center Adult Intake?
The Texana Center Adult Intake form is required for individuals who are seeking assistance, support, or services from Texana Center. This includes individuals who feel they may benefit from mental health support, substance abuse treatment, or any other specific services offered by Texana Center. It is important for those who need these services to complete the intake form accurately and thoroughly in order to receive the appropriate care and support.
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