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Child Intake Form

Confidential Child Intake Information

As part of the initial intake and assessment process, we would like you to complete the attached questions. This will provide us with an overview of your child’s development and challenges thus far.

You might not know all the answers, that is okay. Also, you are certainly free to choose not to answer any questions if you would like that to remain private. Keep in mind that the purpose of all the information in these forms is to help you and your child address the current challenges in the best possible ways.

Once you have completed the questions, your psychologist will review the information with you and there is enough opportunity to further discuss things, if you wish to do so.

If yes, you will be required to bring in a copy of these orders at your first sessions, for us to keep on file. Also, in the event of shared legal custody, both parents will need to provide authorization for the child to attend sessions.