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Get the free Child Intake packet without HIPAA disclosure

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InMind, LLC Counseling and Wellness **This form is completely confidential.** Child Client Information Todays Date: ___ Client Name: ___Date of Birth: ___ Age: ___Gender assigned at birth ___ Parent/Legal
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Gather all necessary information and forms needed to complete the intake packet.
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Read through each section of the intake packet carefully.
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Fill out all required information accurately and legibly.
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Submit the intake packet to the appropriate recipient as instructed.

Who needs child intake packet without?

01
Parents or guardians who are enrolling their child in a new school or program.
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Healthcare providers or therapists seeing a new child patient.
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Childcare providers or daycare centers requiring information for new enrollees.
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