New Clients (Sarah)

    • 1

      Client Information

    • 2

      Background Information

    • 3

      Demographic Information

    • 4

      Presenting Concerns

    • 5

      Informed Consent & Counseling Agreement

    • 6

      Confirmation

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    Client Information

    Client Information









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    Background Information



    Parent Information



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    Family History



    Emergency Contact





    Presenting Concern






    Physician Information



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    Alcohol & Substance Concerns











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    Demographic Information (optional... may skip this section)

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    Presenting concerns (check all that apply)

    Treatment Goals (what do you want to accomplish with counseling?)



    Additional Information

    Step 5

    Confirmation