This form helps me better understand you and/or your child’s needs prior to our first session.
Please feel free to skip any questions that do not apply or feel too personal to answer in writing; we can always discuss them together.
You can submit this form electronically (by typing your signature) or print it and sign by hand. Both methods have the same legal effect.
Complete if client is a minor or if a family member is participating in care.
Sign this intake form by typing your name, your email, your relationship to the client, today's date, and checking the agreement box below. Under the federal ESIGN Act and Minnesota's Uniform Electronic Transactions Act (UETA), your typed name has the same legal effect as a handwritten signature when provided with the intent to sign. To sign on paper instead, print this form and complete the same fields by hand.
Please confirm everything looks right before sending.
