Intake interviews are designed to answer a number of … Career counseling knowledge. Completed release of information as indicated. 0000021608 00000 n counseling skills needed. In most mental health agencies, clients are seen for an intake interview before treatment begins. These include: (a) establishing a relationship so that counseling can continue, (b) developing the client's psychological realities so that the goals of counseling can be conceptualized, and (c) agreeing on the structure and plan for further counseling and related activities. (i.e. The intake interview is an important step in the counseling process. 0000002640 00000 n the major. FAMILY CONCERNS (Please check any family concerns that your family is currently experiencing) Fighting Disagreeing about relatives Feeling distant Disagreeing about friends Loss of fun Alcohol or Drug use Lack of honesty Trauma Medical Concerns Infidelity (couple) Education problems Divorce/separation Client Intake Questionnaire Please fill in the information below and bring it with you to your first session. GENERAL INFORMATION First Name Last Name Gender Date of Birth (mm/dd/yyyy) Social Security Number Address City State Zip Code Main Phone Other Phone Email Adult Intake Questionnaire Page 1 of 8 Intake Questionnaire For New Patients (Adult) This questionnaire is for the purpose of getting to know you better in order to provide the best possible mental health services. 0000026220 00000 n startxref GUILFORD COUNSELING, PLLC Adult & Adolescent Intake Interview (336) 337-5469 430 BATTLEGROUND AVE GREENSBORO NC 27401 CLIENT Updated October 2013 Confidential property of Guilford Counseling, PLLC Page 1 of 4 INFORMATION First … In order to participate in New Day, you must be enrolled in the program and parent(s) must have attended a brief intake interview. 4. This section addresses the intake interview; 0000018910 00000 n intake form, as used in community agencies, provides a structured interview process. 4 0 obj What is the problem that led you to decide to come to couples therapy? endobj The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Demographic Information: Name: Date: Date of Birth: Relationship Status: What initially attracted you to your partner? Intake Assessment Form. Before initiating counseling, psychotherapy, or psychiatric treatment, it's usually necessary and always wise to conduct an intake interview. People present at the initial interview: _____ (Name and relationship) Reviewed intake form and referral information. 185 0 obj <> endobj Approach: Your therapist will complete an intake assessment to understand how your current difficulties may have developed and are maintained within the various contexts of your life. Download preview PDF. Our office staff will A counseling intake is the first step in every counseling relationship. 0000016827 00000 n 0000043811 00000 n Open-Ended Questions: Open-ended questions encourage people in a counseling session to … Segal and others published Writing up the Intake Interview | Find, read and cite all the research you need on ResearchGate All information that you provide us will be Counselor, Psychiatrist, Psychologist, Marriage/Family Counselor). endobj <>>> Thank you for visiting. 0000009708 00000 n 225 0 obj <>stream stream 185 41 Information Known to Clienf. %PDF-1.5 Counselors in private practice also typically conduct a comprehensive initial interview, although this process may not be labelled as a formal intake procedure. ... Have you had any difficulties or concerns related to food intake? 0000075345 00000 n After your intake form is received by mail, our office staff will begin the interview and/or placement process. In what form (e.g., dating, living together, married)? 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