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SE RDC HEALTH MENTAL WELLNESS PROGRAMREFERRAL FORM Date: Completed by:What program is the client being referred to? (required) Tribal NSDAP Program Mental Wellness Program IRS Program IDENTIFYING
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Gather all necessary documents and information. This may include personal identification, medical history, and contact information.
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Begin by providing general personal information such as name, date of birth, and address.
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Who needs mental wellness intake?

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Anyone who is seeking mental health support or wishes to address their emotional well-being can benefit from completing a mental wellness intake.
02
Individuals experiencing symptoms of mental health conditions such as depression, anxiety, or stress may find it helpful to go through a mental wellness intake.
03
People who are seeking therapy, counseling, or support services from mental health professionals often need to fill out a mental wellness intake as part of the initial assessment process.
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Mental wellness intake forms are used by both adults and minors, so anyone in need of mental health assistance, regardless of age, may be required to complete the intake process.
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Mental wellness intake is the process of gathering information about an individual's mental health status, concerns, and needs, often conducted during an initial assessment by a mental health professional.
Individuals seeking mental health services or support typically need to complete a mental wellness intake. This may also apply to organizations providing mental health services for their clients.
To fill out a mental wellness intake, provide accurate and honest responses to all questions regarding your mental health history, current issues, and any previous treatments. Follow the guidelines provided by the mental health provider.
The purpose of mental wellness intake is to assess an individual's mental health needs, identify specific issues, and determine an appropriate treatment or support plan.
Information required typically includes personal details, mental health history, current symptoms, medications, previous treatments, and any relevant family history.
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