This form provides a variety of information needed at the first appointment. Demographic information includes your legal name, address, phone numbers, and an emergency contact. We also request information about medication, substance use, past providers, and interests to help us better understand you. Finally, there is a symptoms checklist that helps the therapist to understand your reasons for seeking assistance. Please print this, complete it, and bring it to your initial appointment. If the individual referred is 18 and still in high school, please complete the youth intake form.
Informed consent stems from the from the mental health provider's ethical duty to ensure that the client or their legal guardian is involved in decisions about his or her own treatment. The process of ensuring informed consent involves information exchanged between therapist and client and is a part of patient education. In words the client can understand, the therapist conveys the details of a treatment or procedure, its potential benefits and serious risks, and any feasible alternatives. The attached document covers this requirement. Please print it, review it, and if no questions sign it. At the first appointment we review informed consent and any questions are answered.