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Child/Adolescent Assessment Page 1 Child and Adolescent Intake and Assessment Name: Date: Who referred you? What is the reason you are seeing a therapist? All the FOLLOWING QUESTIONS ARE ABOUT THE

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How to fill out child and adolescent intake:

1. Begin by gathering all necessary information about the child or adolescent, such as their personal details, medical history, and current symptoms or concerns.
2. Ensure that the intake form is clear and concise, providing space for both the child/adolescent and their parent or guardian to provide accurate and relevant information.
3. Start with the child/adolescent's personal details, including their name, age, gender, and contact information. If applicable, also provide details about their parent or guardian.
4. Move on to the medical history section, where you ask about any previous illnesses, allergies, medications, hospitalizations, or surgeries the child/adolescent has had. Make sure to inquire specifically about any mental health concerns or treatment history.
5. Inquire about the current symptoms or issues that prompted the need for the intake. Ask about the duration, severity, and any triggering factors or patterns. Give enough space for the child/adolescent and their parent or guardian to provide detailed descriptions.
6. Include a section to capture the child/adolescent's social, family, and educational background. This might involve asking about their school, friendships, familial relationships, and any significant life events or stressors.
7. Provide a section for relevant contact information, such as emergency contacts or other healthcare providers involved in the child/adolescent's care.
8. Include a consent and confidentiality agreement, ensuring that the parent or guardian understands the purpose of the intake and agrees to share the information provided within appropriate channels.
9. Finally, conclude the intake form with a signature section for both the child/adolescent and their parent or guardian to acknowledge the accuracy and completeness of the information provided.

Who needs child and adolescent intake?

1. Child and adolescent intake forms are necessary for healthcare providers, including doctors, therapists, psychologists, and counselors, who specialize in pediatric or adolescent care.
2. These intake forms are also important for educational institutions, particularly schools or programs that cater to children and adolescents with special needs or mental health concerns.
3. Additionally, child and adolescent intake forms may be required by government agencies or social service organizations involved in child welfare, foster care, or adoption processes.

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What is child and adolescent intake?

Child and adolescent intake is the process of gathering information about a child or adolescent entering a specific program or service.

Who is required to file child and adolescent intake?

Parents, guardians, or authorized caregivers are typically required to file child and adolescent intake forms.

How to fill out child and adolescent intake?

Child and adolescent intake forms can usually be filled out online, by phone, or in person at the relevant organization or agency.

What is the purpose of child and adolescent intake?

The purpose of child and adolescent intake is to collect necessary information to provide appropriate services and support to children and adolescents.

What information must be reported on child and adolescent intake?

Child and adolescent intake forms typically require information such as personal details, health history, educational background, and any specific needs or concerns.