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Huron Valley Consultation Center Ann Arbor, Michigan CHILD INTAKE INFORMATION Intake Date Case # Patient Name: Address: Street City State Zip Parents: Mother Age Father Age Parents Address if different:
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How to fill out intake-child 11-15docx - huronvalleyconsult:
01
Download the intake-child 11-15docx form from the huronvalleyconsult website.
02
Open the document in a compatible software program, such as Microsoft Word.
03
Begin by filling out the personal information section, including the child's full name, date of birth, and address.
04
Provide contact information for both the child and their parent or guardian, including phone numbers and email addresses.
05
Indicate the reason for seeking consultation or therapy services in the designated section.
06
Answer any additional questions related to the child's medical history and previous therapy experiences, if applicable.
07
Provide details about the child's current school or educational setting, including the name of the school and the grade they are enrolled in.
08
Mention any specific concerns or issues that the child is dealing with, which may require extra attention from the therapist.
09
Sign and date the document, indicating your agreement and consent for the child to receive services from huronvalleyconsult.
10
Keep a copy of the completed form for your records.
Who needs intake-child 11-15docx - huronvalleyconsult:
01
Parents or guardians who are seeking consultation or therapy services for their child aged between 11 and 15.
02
Individuals who want to provide comprehensive information about their child's background, medical history, and current concerns to the huronvalleyconsult team.
03
Those who are interested in ensuring a thorough assessment is conducted to determine the best course of action for their child's therapy needs.
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What is intake-child 11-15docx - huronvalleyconsult?
intake-child 11-15docx - huronvalleyconsult is a form used by the Huron Valley Consultancy to collect information about children aged 11-15 for intake purposes.
Who is required to file intake-child 11-15docx - huronvalleyconsult?
Parents or guardians of children aged 11-15 are required to fill out and file intake-child 11-15docx with Huron Valley Consultancy.
How to fill out intake-child 11-15docx - huronvalleyconsult?
The form should be filled out with accurate information about the child's personal and medical history, as well as any other relevant details requested by the consultancy.
What is the purpose of intake-child 11-15docx - huronvalleyconsult?
The purpose of intake-child 11-15docx is to gather necessary information about the child to provide better care and support services by Huron Valley Consultancy.
What information must be reported on intake-child 11-15docx - huronvalleyconsult?
The form typically requires details about the child's name, age, address, medical history, emergency contacts, and any specific needs or concerns.
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