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  • Client Intake 2024

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    skbridges
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    The document appears to be an intake form for counseling at an organization called Advanced Theories. It collects basic contact information like name, phone number, email, age, gender, ethnicity, as well as information on the client's presenting problem, what issues bring them to counseling, how they have tried to address these problems previously, their reasons for seeking help now, and how they will measure improvement. It also requests permission to audio or video tape sessions.

    Original Description:

    Intake form for class practice in Advanced Theories.

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    The document appears to be an intake form for counseling at an organization called Advanced Theories. It collects basic contact information like name, phone number, email, age, gender, ethnicity, as well as information on the client's presenting problem, what issues bring them to counseling, how they have tried to address these problems previously, their reasons for seeking help now, and how they will measure improvement. It also requests permission to audio or video tape sessions.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    Download as doc, pdf, or txt
    7 views1 page

    Client Intake 2024

    Uploaded by

    skbridges
    The document appears to be an intake form for counseling at an organization called Advanced Theories. It collects basic contact information like name, phone number, email, age, gender, ethnicity, as well as information on the client's presenting problem, what issues bring them to counseling, how they have tried to address these problems previously, their reasons for seeking help now, and how they will measure improvement. It also requests permission to audio or video tape sessions.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 1

    Advanced Theories

    Fall 2024
    INTAKE INFORMATION

    DEMOGRAPHICS

    Name:

    Phone Number: E-mail:

    How should we contact you, if needed?

    Age: Gender:

    Partner Status: Ethnicity:

    Previous Counseling:

    PRESENTING PROBLEM
    What brings you to counseling today?

    How have you attempted to work on these problems in the past?

    Reason for seeking help with this problem at this time (why now instead of last month or next week or next year)?

    How will you know that counseling has worked for you?

    Permission to tape: ____audio ____video ____refuse both

    Client’s Signature Date and Time

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