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Behavioral Health Child/Adolescent Intake Form Child Name (First, MI, Last)Age Date of Birth Schoolmate Grade Today's Date Primary M.D. Social WorkerCounty Who Referred You? What are the current concerns?
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Behavioral health child/adolescent intake is the process of gathering information about a child or adolescent's mental health history, symptoms, and treatment needs.
Parents, legal guardians, or caregivers are typically required to file behavioral health child/adolescent intake forms.
Behavioral health child/adolescent intake forms can usually be filled out online, over the phone, or in person with a mental health professional.
The purpose of behavioral health child/adolescent intake is to assess the mental health needs of a child or adolescent and determine appropriate treatment options.
Information such as medical history, behavioral concerns, current symptoms, and any previous mental health treatments should be reported on a behavioral health child/adolescent intake form.
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