Has your child ever tried, or does your child currently use, any chemical substances? Please list alcohol, tobacco, illegal substances, over-the-counter medications and prescription medications.

Please tell us about any other mental health professionals your child has consulted with in the past (approximate dates, type of professional seen, reason for the consultation, nature of the …

In the first two years, did your child experience: ___Separation from mother, ___Out of home care, ___Disruption in bonding, ___Depression of mother, ___Abuse,

Use this secure child therapy intake form to collect important background and behavioral information before a child’s first appointment. It’s a simple way to protect the sensitive …

Please complete this form as honestly and completely as possible. All information that you provide us will be confidential as required by state and federal law.

This consent form explains the nature of the psychological services that your child is about to receive. As consent is an ongoing process, any changes that may influence your consent will …

Biographical Information – New Child Client Intake Form Please fill out this biographical background form as completely and openly as possible for each child in therapy.

How long do you expect to be in therapy in order to accomplish these goals (or at least feel like you have the tools to accomplish them on your own)?

Use this Child Therapy Intake Form to gather key information about a child’s emotional, behavioral, and developmental history. Designed for therapists, counselors, and pediatric …

Our Child Intake Form for Therapy PDF Template can be downloaded and used with all your child / adolescent clients for each treatment session.