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Child/Adolescent Intake Form PLEASE PRINT CLEARLYChilds Full Name:Today's Date Child's Date of Birth:Address (Street, City, Zip):Gender:MALEFEMALEParent/Guardian Phone:Can we leave a private message
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The child/adolescent intake form is a document used to gather information about a child or adolescent's background, health, and overall well-being.
Parents, guardians, or caregivers of the child or adolescent are typically required to file the intake form.
The form can be filled out by providing accurate information about the child or adolescent's personal details, medical history, and any other relevant information requested on the form.
The purpose of the intake form is to help healthcare professionals and social workers gain a better understanding of the child or adolescent's needs and provide appropriate care and support.
The form may require information such as the child's name, age, medical history, any known allergies, medications, and any pre-existing conditions.
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